-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, Hhviypy+vcoURgy76s92bFXyG28Wvj4cfVPAr1JprzS/ZRn2Yg3ZqgtbyhAVsMA7 rE5xFvQgJWcbQuqWt2Tktg== 0000914121-00-000179.txt : 20000216 0000914121-00-000179.hdr.sgml : 20000216 ACCESSION NUMBER: 0000914121-00-000179 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19991231 FILED AS OF DATE: 20000215 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: LODGIAN INC CENTRAL INDEX KEY: 0001066138 STANDARD INDUSTRIAL CLASSIFICATION: HOTELS & MOTELS [7011] IRS NUMBER: 522093696 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 5 SEC ACT: SEC FILE NUMBER: 001-14537 FILM NUMBER: 545766 BUSINESS ADDRESS: STREET 1: 3445 PEACHTREE ROAD N E SUITE 700 CITY: ATLANTA STATE: CA ZIP: 30326 BUSINESS PHONE: 4043649400 MAIL ADDRESS: STREET 1: 3445 PEACHTREE ROAD N E SUITE 700 CITY: ATLANTA STATE: CA ZIP: 30326 COMPANY DATA: COMPANY CONFORMED NAME: LANG JOHN M CENTRAL INDEX KEY: 0001074125 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 5 BUSINESS ADDRESS: STREET 1: 3399 PEACHTREE ROAD N E SUITE 2050 CITY: ATLANTA STATE: GA ZIP: 30326 BUSINESS PHONE: 4048129003 MAIL ADDRESS: STREET 1: 3399 PEACHTREE ROAD N E SUITE 2050 CITY: ATLANTA STATE: GA ZIP: 30326 5 1 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP - ------------------------- ------------------------------ FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION OMB Approval - ------------------------- Washington, D.C. 20549 ------------------------------ [ ] Check this box if no OMB Number: 3235-0362 longer subject to Expires: December 31, 2001 Section 16. Form 4 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Estimated average burden or Form 5 obligations hours per response.......1.0 may continue. See ------------------------------ Instruction 1(b). Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, [ ] Form 3 Holdings Section 17(a) of the Public Utility Holding Company Act of 1935 or Reported Section 30(f) of the Investment Company Act of 1940 [ ] Form 4 Transactions Reported
- --------------------------------------------------- ------------------------------------------------------ ------------------------- 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) Lodgian, Inc. LOD Lang John M. [X] Director [ ] 10% Owner - ---------------------------------------------------------------------------------------- [ ] Officer (give [ ] Other (specify (Last) (First) (Middle) 3. IRS or Social 4. Statement for title below) Security Number of Month/Year below) Reporting Person c/o Lodgian, Inc. (Voluntary) 12/99 3445 Peachtree Road, N.E., Suite 700 ------------------------------------ - ------------------------------------------ --------------------------------------------------------------- (Street) 5. If Amendment, 7. Individual or Joint/Group Reporting Date of Original (check applicable line) (Month/Year) [X] Form Filed by One Reporting Person [ ] Form Filed by More than One Reporting Atlanta GA 30326 Person - ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Transaction 4. Securities Acquired (A) 5. Amount of 6. Ownership 7. Nature of (Instr. 3) action Code (Instr. or Disposed of (D) Securities Form: Indirect Date 8) (Instr. 3, 4 and 5) Beneficially Direct (D) Beneficial (Month/ Owned at End or Indirect Ownership Day/ of Issuer's (I) (Instr. 4) Year) Fiscal Year (Instr. 4) (Instr. 3 and 4) - ------------------------------------------------------------------------------------------------------------------------------------ Amount (A) or (D) Price - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ * If the form is filed by more than one reporting person, see Instruction 4(b)(v). Page 1 of 2 SEC 2270 (3-99)
FORM 5 (continued) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (e.g., puts, calls, warrants, options, convertible securities) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date 7. Title 8. Price 9. Number 10. Owner- 11. Nature of of sion or action action Derivative Exer- and of of ship Indirect Deri- Exercise Date Code Securities cisable Amount Deri- Deri- Form Beneficial vative Price of (Instr. Acquired (A) and Expi- of vative vative of Deri- Ownership Secu- Deri- (Month/ 8) or Disposed ration Under- Secu- Secu- vative (Instr. 4) rity vative Day/ of (D) Date Lying rity rities Security: (Instr. Security Year) (Instr. 3, (Month/ Securi- (Instr. Benefi- Direct 3) 4, and 5) Day/ ties 5) cially (D) or Year) (Instr. Owned Indirect 3 and 4) at End (I) of (Instr. Year 4) (Instr. 4) --------------------------------------------------- (A) (D) Date Expir- Title Amount Exerci- ation or sable Date Number of Shares --------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------ Option to $6.50 6/25/99 A 5,000 6/25/99 6/25/09 Common 5,000 5,000 D Purchase Stock Common Stock, par value $0.01/share - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: None ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Note: File three copies of this Form, one of which must be manually /s/ John M. Lang February 10, 2000 signed. If space is insufficient, see Instruction 6 for ------------------------------------ -------------------- procedure. ** Signature of Reporting Person Date Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. Page 2 of 2 SEC 2270 (3-99)
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