4 1 lo-hawthorne_form4.txt STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP ------------------------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION ------------------------------ FORM 4 WASHINGTON, D.C. 20549 OMB Approval ------------------------- ------------------------------ [ ] Check this box if no STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB Number: 3235-0287 longer subject to Expires: January 31, 2005 Section 16. Form 4 Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Estimated average burden or Form 5 obligations Section 17(a) of the Public Utility Holding Company Act of 1935 or hours per response.......0.5 may continue. See Section 30(h) of the Investment Company Act of 1940 ------------------------------ Instruction 1(b).
(Print or Type Responses) ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person(s) to Issuer Lodgian, Inc.; LGN (Check all applicable) Hawthorne David E. [X] Director [ ] 10% Owner ------------------------------------ ----------------------------------------------- [X] Officer (give [ ] Other (specify (Last) (First) (Middle) 3. I.R.S. Identification 4. Statement for title below) Number of Reporting Month/Day/Year below) Person, if an entity c/o Lodgian, Inc. (Voluntary) 2/13/2003 President and Chief Executive Officer 3445 Peachtree Road, N.E., Suite 700 -------------------------------------- ------------------------------------ ----------------------------------------------------------- (Street) 5. If Amendment, 7. Individual or Joint/Group Filing Date of (Check Applicable Line) Original [X] Form filed by One Reporting Person Atlanta, GA 30326 (Month/Day/Year) [ ] Form filed by More than One ------------------------------------ Reporting Person (City) (State) (Zip) ------------------------------------------------------------------------------------------------------------------------------------ TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 2A. Deemed 3. Transaction 4. Securities Acquired (A) 5. Amount of 6. Ownership 7. Nature of (Instr. 3) action Execu- Code (Instr. or Disposed of (D) Securities Form: Indirect Date tion 8) (Instr. 3, 4 and 5) Beneficially Direct (D) Beneficial Date, Owned or Indirect Ownership if any Following (I) (Instr. 4) Reported (Instr. 4) (Month/ (Month/ Transaction(s) Day/ Day/ (Instr. 3 Year) Year) and 4) ------------------------------------------------------------------------------------------------------------------------------------ Code V Amount (A) or (D) Price ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par 2/13/03 P 1000 (A) $3.00 1,000 (D) value $0.01 per share ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ 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 4(b)(v). Page 1 of 2 SEC 1475 (9-02)
FORM 4 (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- 3A. 4. Trans- 5. Number of 6. Date 7. Title 8. Price 9. Number 10. Owner- 11. Nature of of sion or action Deemed action Derivative Exer- and of of ship Indirect Deriv- Exercise Date Execu- Code Securities cisable Amount Deriv- deriv- Form of Beneficial ative Price of tion (Instr. Acquired (A) and Expi- of ative ative Deriv- Ownership Secu- Deriv- (Month/ Date, 8) or Disposed ration Under- Secu- Secu- ative (Instr. 4) rity ative Day/ if any of (D) Date lying rity rities Secu- (Instr. Security Year) (Instr. 3, (Month/ Securi- (Instr. Benefi- rity: 3) (Month/ 4, and 5) Day/ ties 5) cially Direct Day/ Year) (Instr. Owned (D) or Year) 3 and 4) Follow- Indirect ing (I) Reported (Instr. Trans- 4) action(s) (Instr. 4) ----------------------------------------------------------------------------------------------------------------------------------- Code V (A) (D) Date Expir- Title Amount Exerci- ation or sable Date Number of Shares ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- /s/ David E. Hawthorne February 14, 2003 ------------------------------------------ --------------------------- ** Signature of Reporting Person Date ** 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. 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 Number. Page 2 of 2 SEC 1475 (9-02)