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U.S. 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
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OMB APPROVAL
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FORM 3 OMB Number: 3235-0104
- ----------------------------------- Expires: December 31, 2001
Estimated average burden
hours per response .... 0.5
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1. Name and Address of Reporting Person *
Casuarina Cayman Holdings Ltd.
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(Last) (First) (Middle)
207 Grandview Drive
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(Street)
Fort Mitchell KY 41017
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(City) (State) (Zip)
2. Date of Event Requiring Statement ( Month / Day / Year )
12/20/99
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Issuer Name and Ticker or Trading Symbol
Lodgian, Inc./LOD
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5. Relationship of Reporting Person to Issuer (Check all applicable)
Director X 10% Owner
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Officer (give title Other
----- below) ----- (specify
below)
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6. If Amendment, Date or Original (Month/Year)
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7. Individual or Join/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
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X Form filed by More than One Reporting Person
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TABLE I -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED
1. Title of security 2. Amount of Securities 3. Ownership 4. Nature of Indirect
(Inst.4) Beneficially Owned Form: Direct (D) Beneficial Ownership
(Instr. 4) or Indirect (I) (Instr. 5)
(Inst. 5)
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Common Stock, par value $0.01 per share 2,941,700 (1) (1)
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over)
* If the Form is filed by more than one reporting person, SEE instruction 5(b)(v). SEC 1473(8-92)
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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.
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FORM 3 (CONTINUED) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS,
CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
1. Title of Derivative Security 2. Date Exercisable and 3. Title and Amount of Securities Underlying
(Instr. 4) Expiration Date Derivative Security (Instr. 4)
(Month/Day/Year)
Amount or
Date Expiration Title Number of
Exercisable Date Shares
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None.
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4. Conversion or 5. Ownership 6. Nature of Indirect
Exercise Price of Form of Beneficial Ownership
Derivative Derivative (Instr. 5)
Security Security:
Direct (D) or
Indirect (I)
(Instr. 5)
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Explanation of Responses: (1) Casuarina Cayman Holdings Ltd. ("Casuarina")
directly owns 343,600 shares of Lodgian, Inc. Common Stock, par value $0.01 per
share (the "Shares"). Because William J. Yung may be deemed to control
Casuarina, William J. Yung and Casuarina may be deemed to have beneficial
ownership and voting and dispositive control of all such Shares held directly by
Casuarina. In addition, the 1994 William J. Yung Family Trust (the "1994
Trust"), The 1998 William J. Yung and Martha A. Yung Family Trust (the "1998
Trust"), Edgecliff Management, LLC ("Management"), Edgecliff Holdings LLC
("Holdings"), Joseph Yung and William J. Yung, may pursuant to Rule 13d-5 of the
Securities Exchange Act of 1934 (the "Securities Act"), be deemed to be the
beneficial owner of the 343,600 Shares owned directly by Casuarina. Holdings
directly owns 2,598,100 Shares. William J. Yung as the sole managing member of
Management, which is the sole managing member of Holdings, may be deemed to
control Holdings and, therefore, William J. Yung and Holdings may be deemed to
have beneficial ownership and voting and dispositve control of all such Shares
held of record by Holdings. In addition, Casuarina, the 1994 Trust, the 1998
Trust, Management, Joseph Yung and William J. Yung, may, pursuant to Rule 13d-5
of the Securities Act, be deemed to be the beneficial owner of the 2,598,100
Shares owned directly by Holdings.
CASUARINA CAYMAN HOLDINGS, LTD.
/s/ William J. Yung December 29, 1999
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**Signature of Reporting Person Date
Name: William J. Yung
Title: President
**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.
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Joint Filer Information
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Designated Filer: Casuarina Cayman Holdings Ltd.
Issuer and Ticker Symbol: Lodgian, Inc./LOD
Date of Event
Requiring Statement: December 20, 1999
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Listing of Names and Addresses
of Other Reporting Persons Signatures of Other Reporting Persons Date
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Edgecliff Holdings, LLC EDGECLIFF HOLDINGS, LLC
207 Grandview Drive
Fort Mitchell, KY 41017 By: /s/ William J. Yung 12/29/99
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Name: William J. Yung
Title: President
Edgecliff Management, LLC EDGECLIFF MANAGEMENT, LLC
207 Grandview Drive
Fort Mitchell, KY 41017 By: /s/ William J. Yung 12/29/99
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Name: William J. Yung
Title: President
1994 William J. Yung Family Trust 1994 WILLIAM J. YUNG FAMILY
207 Grandview Drive TRUST
Fort Mitchell, KY 41017
By: The Fifth Third Bank, as Trustee
By: /s/ Timothy A. Rodgers 12/29/99
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Name: Timothy A. Rodgers
Title: Trust Officer
Joseph Yung /s/ Joseph Yung 12/29/99
207 Grandview Drive ------------------------------------ --------
Fort Mitchell, KY 41017 Joseph Yung
William J. Yung /s/ William J. Yung 12/29/99
1200 Cypress Street ------------------------------- --------
Cincinnati, OH 45206
The 1998 William J. Yung 1998 WILLIAM J. YUNG
and Martha A. Yung Family Trust AND MARTHA A. YUNG FAMILY
207 Grandview Drive TRUST
Fort Mitchell, KY 41017
By: The Fifth Third Bank, as Trustee
By: /s/ Timothy A. Rodgers 12/29/99
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Name: Timothy A. Rodgers
Title: Trust Officer
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