-----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, UC6TRGlAbA9M+z3NEcYmupr3w+R4/XMIsgCN37n9sb2Cu8dZTfgeBK8LocYBVACt T4HDTTNNEU+PkzqLhWjENw== 0000914121-98-001091.txt : 19981228 0000914121-98-001091.hdr.sgml : 19981228 ACCESSION NUMBER: 0000914121-98-001091 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19981211 FILED AS OF DATE: 19981222 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: SEC FILE NUMBER: 001-14537 FILM NUMBER: 98773219 BUSINESS ADDRESS: STREET 1: 1601 BELVEDERE RD CITY: WEST PALM BEACH STATE: FL ZIP: 33406 BUSINESS PHONE: 5616899970 MAIL ADDRESS: STREET 1: 1601 BELVEDERE RD CITY: WEST PALM BEACH STATE: FL ZIP: 33406 COMPANY DATA: COMPANY CONFORMED NAME: MARASCO KARYN CENTRAL INDEX KEY: 0001075614 STANDARD INDUSTRIAL CLASSIFICATION: [] OFFICER FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: C/O LODGIAN INC STREET 2: 3445 PEACHTREE ROAD NE SUITE 700 CITY: ATLANTA STATE: GA ZIP: 30326 BUSINESS PHONE: 4043649400 MAIL ADDRESS: STREET 1: C/O LODGIAN INC STREET 2: 3445 PEACHTREE ROAD NE SUITE 700 CITY: ATLANTA STATE: GA ZIP: 30326 3 1 FORM 3 - -------------------------------------------------------------------------------- FORM 3 - -------------------------------------------------------------------------------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 - ------------------------------------- OMB Approval - ------------------------------------- OMB Number: 3235-0104 Expires: September 30, 1998 Estimated average burden hours per response.........0.5 - ------------------------------------- - -------------------------------------------------------------------------------- (Print or Type Responses) 1. Name and Address of Reporting Person* Guttierez Karyn Marasco ---------------------------------------------------------------- (Last) (First) (Middle) c/o Lodgian, Inc. 3445 Peachtree Road, N.E., Suite 700 ---------------------------------------------------------------- (Street) Atlanta GA 30326 ---------------------------------------------------------------- (City) (State) (Zip) 2. Date of Event Requiring Statement (Month/Day/Year) 12/11/98 3. IRS or Social Security Number of Reporting Person (Voluntary) 4. Issuer name and Ticker or Trading Symbol Lodgian, Inc. (formerly known as Servico, Inc.) LOD 5. Relationship of Reporting Person(s) to Issuer (Check all applicable) -- Director -- 10% Owner X Officer (give title below) -- Other (specify below) Chief Operating Officer 6. If Amendment, Date of Original (Month/Day/Year) 7. Individual or Joint/Group Filing (Check applicable Line) X Form Filed by One Reporting Person Form Filed by More than One Reporting Person Table I Non-Derivative Securities Beneficially Owned 1. Title of Security 2. Amount of 3. Ownership 4. Nature of Indirect (Instr. 4) Securities Form: Direct Beneficial Beneficially (D) or Indirect Ownership Owned (I) (Instr. 5) (Instr. 5) (Instr. 4) Common Stock, par value $.01 per share 200 D 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). Potential persons who are to respond to the collection of information contained in this form Page 3 of 2 are not required to respond unless the form displays a currently valid OMB Number. SEC 1473 (7-97)
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. Conver- 5. Owner- 6. Nature of Derivative cisable and Securities Underlying sion or ship Form Indirect Security Expiration Derivative Security Exercise of Deriv- Beneficial (Instr. 4) Date (Instr. 4) Price of ative Ownership (Month/Day/Year) Deri- Security: (Instr. 5) vative Direct (D) or Security Indirect (I) (Instr. 5)
Date Expira- Title Amount or Exer- tion Number of cisable Date Shares Option to Purchase Common Stock 5/6/97 5/6/07 Common Stock 10,000 $6.125 D - ----------------------------------------------------------------------------------------------------------- ----------------- - Option to Purchase Common Stock 5/6/98 5/6/07 Common Stock 10,000 $6.125 D - ----------------------------------------------------------------------------------------------- ----------- ----------------- - Option to Purchase Common Stock 5/6/99 5/6/07 Common Stock 10,000 $6.125 D - --------------------------------------------------------------------------------------------- ----------- ----------------- -- Option to Purchase Common Stock 5/6/00 5/6/07 Common Stock 10,000 $6.125 D - --------------------------------------------------------------------------------------------- ----------- ----------------- -- Option to Purchase Common Stock 5/6/01 5/6/07 Common Stock 10,000 $6.125 D - --------------------------------------------------------------------------------------------- ----------- ----------------- -- Option to Purchase Common Stock 8/27/97 8/27/07 Common Stock 12,500 $6.125 D - -------------------------------------- --------- --------- ------------------------------------ ----------- ----------------- - Option to Purchase Common Stock 8/27/98 8/27/07 Common Stock 12,500 $6.125 D - -------------------------------------- --------- --------- ------------------------------------ ----------- ----------------- - Option to Purchase Common Stock 8/27/99 8/27/07 Common Stock 12,500 $6.125 D - -------------------------------------- --------- --------- ------------------------------------ ----------- ----------------- - Option to Purchase Common Stock 8/27/00 8/27/07 Common Stock 12,500 $6.125 D - -------------------------------------- --------- --------- ------------------------------------ ----------- ----------------- - Option to Purchase Common Stock 8/27/01 8/27/07 Common Stock 12,500 $6.125 D - -------------------------------------- --------- --------- ------------------------------------ ----------- ----------------- - Stock Appreciation Rights 8/27/97 8/27/07 Common Stock 12,500 $6.125 D - -------------------------------------- --------- --------- ------------------------------------ ----------- ----------------- -
**Intentional mistatements 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 /s/ Karyn Marusco Guttierez Dec. 21, 1998 - ---------------------------- --------------- Karyn Marusco Guttierez **Signature of Reporting Person Potential persons who are to respond to the collection of information contained in this form Page 3 of 2 are not required to respond unless the form displays a currently valid OMB Number. SEC 1473 (7-97) -----END PRIVACY-ENHANCED MESSAGE-----