-----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, PhkHIYWJ0yTktkumDDm66O4emdgeQJVnDRK60VFklMZg6jJExVIU8kPK+4JWj2UQ KjlbthY04hV1hO35h3TXPQ== 0000914121-99-000733.txt : 19990805 0000914121-99-000733.hdr.sgml : 19990805 ACCESSION NUMBER: 0000914121-99-000733 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19990731 FILED AS OF DATE: 19990804 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: 4 SEC ACT: SEC FILE NUMBER: 001-14537 FILM NUMBER: 99677524 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: TYSON PETER R CENTRAL INDEX KEY: 0001075612 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 4 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 4 1 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP - ------------------------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION ------------------------------ FORM 4 Washington, D.C. 20549 OMB Approval - ------------------------- STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP ------------------------------ [ ] Check this box if no OMB Number: 3235-0287 longer subject to Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Expires: Section 16. Form 4 Section 17(a) of the Public Utility Holding Company Act of 1935 or Estimated average burden or Form 5 obligations Section 30(f) of the Investment Company Act of 1940 hours per response.......0.5 may continue. See ------------------------------ Instruction 1(b).
(Print or Type Responses) - ------------------------------------------------------------------------------------------------------------------------------------ 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker 4. Statement for 6. Relationship of Reporting Person(s) or Trading Symbol Month/Year to Issuer (Check all applicable) Tyson Peter R. Lodgian, Inc. 7/99 [X] Director [ ] 10% Owner ------------------------------------ [ ] Officer (give [ ] Other (Last) (First) (Middle) LOD title below) (specify below) c/o Lodgian, Inc. 3445 Peachtree Road, N.E., Suite 700 --------------------------------------- ------------------------------------ ----------------------------------------------------------------------------------------- (Street) 3. I.R.S. Identification 5. If Amendment, 7. Individual or Joint/Group Filing Number of Reporting Date of (Check Applicable Line) Person, if an entity Original [X] Form Filed by One Reporting Person Atlanta GA 30326 (Voluntary) (Month/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- 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 Month (I) (Instr. 4) Year) (Instr. 3 (Instr. 4) and 4) - ------------------------------------------------------------------------------------------------------------------------------------ Code V Amount (A) or (D) Price - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par 7/9/99 P 200 A 6.625 500 (1) D value $.01 per share - ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par 200 (1) I By self as value $.01 per share custodian for children - ------------------------------------------------------------------------------------------------------------------------------------ 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 1474 (7-97)
FORM 4 (continued)
TABLE II -- DERIVATIVE SECURITIES 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. Month 4) (Instr. 4) - ------------------------------------------------------------------------------------------------------------------------------------ Code V (A) (D) Date Expir- Title Amount Exerci- ation or sable Date Number of Shares - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: (1) The Reporting Person claimed in his Initial Statement of Beneficial Ownership of Securities on Form 3 direct beneficial ownership of 600 shares of the Issuer's stock. The Reporting Person now disclaims beneficial ownership of 100 of those shares, which were owned by the Reporting Person's former spouse, and claims indirect beneficial ownership of 200 of those shares, which the Reporting Person owns as custodian for his children. ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. and 15 U.S.C. 78ff(a). /s/ Peter R. Tyson August 4, 1999 -------------------------------------------- --------------------------- ** Signature of Reporting Person Date 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 form displays a currently valid OMB number. Page 2 of 2 SEC 1474 (7-97)
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