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- ------------------------- 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).
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(Print or Type Responses)
<S> <C> <C> <C>
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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. 8/99 [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)
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TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
<S> <C> <C> <C> <C> <C> <C>
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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)
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Code V Amount (A) or (D) Price
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Common Stock, par 8/13/99 P 200 A $5.00 700 D
value $.01 per share
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Common Stock, par 200 I By self as
value $.01 per share custodian
for
children
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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)
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FORM 4 (continued)
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TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
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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)
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Code V (A) (D) Date Expir- Title Amount
Exerci- ation or
sable Date Number
of
Shares
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Explanation of Responses:
None
** 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 September 1, 1999
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** 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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