-----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, Cbvw3R7NdOfYZPRMc+l90UkA4xiMSg7xZcCcpy9wbbP31GsiEQBNyV999ps7JGGk 6dQ+CGR2t2WPbetU6rn4dA== 0000914121-99-000017.txt : 19990112 0000914121-99-000017.hdr.sgml : 19990112 ACCESSION NUMBER: 0000914121-99-000017 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19981211 FILED AS OF DATE: 19990111 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: SERVICO INC CENTRAL INDEX KEY: 0000089121 STANDARD INDUSTRIAL CLASSIFICATION: HOTELS & MOTELS [7011] IRS NUMBER: 650350241 STATE OF INCORPORATION: FL FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: SEC FILE NUMBER: 001-11342 FILM NUMBER: 99503980 BUSINESS ADDRESS: STREET 1: 1601 BELVEDERE RD STE 501 S CITY: WEST PALM BEACH STATE: FL ZIP: 33406 BUSINESS PHONE: 5616899970 MAIL ADDRESS: STREET 1: 1601 BELVEDERE ROAD CITY: WEST PALM BEACH STATE: FL ZIP: 33406 COMPANY DATA: COMPANY CONFORMED NAME: LEVEN MICHAEL A CENTRAL INDEX KEY: 0001040619 STANDARD INDUSTRIAL CLASSIFICATION: HOTELS & MOTELS [7011] DIRECTOR STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 13 CORPORATE SQUARE STREET 2: STE 250 CITY: ATLANTA STATE: GA ZIP: 30329 BUSINESS PHONE: 4043214045 MAIL ADDRESS: STREET 1: 13 CORPORATE SQUARE STREET 2: STE 250 CITY: ATLANTA STATE: GA ZIP: 30329 FORMER COMPANY: FORMER CONFORMED NAME: LAVEN MICHAEL A DATE OF NAME CHANGE: 19970609 4 1 FORM 4 FILING - ---------------------------- FORM 4 [X]Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). (Print or Type Responses) - ---------------------------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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: 3235-0287 Expires: Estimated average burden hours per response...0.5 - -------------------------------------
- --------------------------------------------------- ------------------------------------------------------ ------------------------- 1. Name and Address of 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person(s) to Issuer Reporting Person* (Check all applicable) X Director __ 10% Owner __ Officer (give title below) __ Other (specify below) Servico, Inc. Leven Michael A. SER - ------------------------------------------------------------------------------------------------------------------------------------ (Last) (First) (Middle) 3. I.R.S. or Social 4. Statement for 7. Individual or Joint/Group Filing Security Number of Month/Year (Check Applicable Line) Reporting Person X Form Filed by One Reporting Person (Voluntary) 12/98 __ Form Filed by More than One Reporting c/o Lodgian, Inc. Person 3445 Peachtree Road, N.E., Suite 700 - ------------------------------------------- ------------------ (Street) 5. If Amendment, Date of Original (Month/Year) Atlanta GA 30326 - ------------------------------------------------------------------------------------------------------------------------------------ (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 - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------------------------------ 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).
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 --------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------ Option to Purchase $6.125 12/11/98 J 5,000 8/27/97 8/27/07 Com- 5,000 0 Common Stock mon Stock, par value $.01 per share - ------------------------------------------------------------------------------------------------------------------------------------ Option to Purchase $6.125 12/11/98 J 20,000 8/27/97 8/27/07 Com- 20,000 0 Common Stock mon Stock, par value $.01 per share - ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: Pursuant to the terms of a merger agreement, shares of common stock and options to purchase common stock of Servico, Inc. have been converted into shares of common stock and options to purchase common stock of Lodgian, Inc., respectively. Servico common stock has been de-registered pursuant to Section 12 of the Securities Exchange Act of 1934. ** Intentional misstatements or omissions of /s/ Michael A. Leven 1/11/99 facts constitute Federal Criminal -------------------------------------------- ------------------------------ Violations. ** Signature of Reporting Person Date See 18 U.S.C. and 15 U.S.C. 78ff(a). Note: File three copies of this Form, one of which must be manually signed. If space provided 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.
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