-----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, Ol4udu36eH+0tczZxCgzuX+bhufRINbjRclugJIf4HZbXJtfXKwZzwamBpV793Ba Bt4RQ4Ztr/23nT9r3n7KXg== 0000914121-02-001365.txt : 20021205 0000914121-02-001365.hdr.sgml : 20021205 20021205165519 ACCESSION NUMBER: 0000914121-02-001365 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021125 FILED AS OF DATE: 20021205 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: MCTAVISH KEVIN C CENTRAL INDEX KEY: 0001208788 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: 5400 LBJ FREEWAY STREET 2: STE 1470 CITY: DALLAS STATE: TX ZIP: 75230 BUSINESS PHONE: 9729828653 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: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-14537 FILM NUMBER: 02850010 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 3 1 lo-tavish_3.txt INITIAL STATEMENT - ------------------------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION ------------------------------ FORM 3 WASHINGTON, DC 20549 OMB APPROVAL - ------------------------- INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES ------------------------------ OMB Number: 3235-0104 FILED PURSUANT TO SECTION 16(a) OF THE SECURITIES EXCHANGE ACT OF 1934, Expires: January 31, 2005 SECTION 17(a) OF THE PUBLIC UTILITY HOLDING COMPANY ACT OF 1935 OR Estimated average burden SECTION 30(h) OF THE INVESTMENT COMPANY ACT OF 1940 hours per response.......0.5 ------------------------------
(Print or Type Responses) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Date of Event Requiring 4. Issuer Name AND Ticker or Trading Symbol Statement (Month/Day/Year) November 25, 2002 Lodgian, Inc. (LDGIV) McTavish Kevin C. ------------------------------------------------------------------------------------- ------------------------------------ 3. I.R.S. Identification 5. Relationship of Reporting 6. If Amendment, Date of (Last) (First) (Middle) Number of Reporting Person(s) to Issuer Original Person, if an entity (Check all applicable) (Month/Day/Year) (voluntary) [X] Director 5400 LBJ Freeway, Ste. 1470 [ ] Officer ---------------------------- ------------------------------------ (give title below) 7. Individual or Joint/Group (Street) [ ] 10% Owner Filing [ ] Other (Check Applicable Line) Dallas, TX 75230 (specify below) [X] Form filed by One ------------------------------------ Reporting Person (City) (State) (Zip) [ ] Form filed by More ------------------------- than One Reporting Person - ------------------------------------------------------------------------------------------------------------------------------------ TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Amount of Securities 3. Ownership Form: Direct (D) 4. Nature of Indirect (Instr. 4) Beneficially Owned or Indirect (I) (Instr. 5) Beneficial Ownership (Instr. 4) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 0 N/A - ------------------------------------------------------------------------------------------------------------------------------------ Series A Preferred Stock 0 N/A - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. * If the form is filed by more than one reporting person, see Instruction 5(b)(v). Persons who 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. (Over) SEC 1473 (3-99)
FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of 2. Date Exer- 3. Title and Amount of 4. Conversion or 5. Ownership 6. Nature of Derivative cisable and Securities Underlying Exercise Price Form of Indirect Security Expiration Derivative Security of Derivative Derivative Beneficial (Instr. 4) Date (Instr. 4) Security Securities: Ownership (Month/Day/Year) Direct (D) or (Instr. 5) Indirect (I) (Instr. 5) - ------------------------------------------------------------------------------------------------------------------------------------ Date Expira- Title Amount or Exer- tion Number of cisable Date Shares - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. /s/ KEVIN C. MCTAVISH December 5, 2002 ----------------------------------- -------------------- ** Signature of Reporting Person Date * If the form is filed by more than one reporting person, see Instruction 5(b)(v). ** 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 signed. If space is insufficient, See Instruction 6 for procedure. Page 2 of 2 SEC 1473 (3-99)
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