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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: December 31, 2001
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)
Lang John M. Lodgian, Inc. 12/99 [X] Director [ ] 10% Owner
------------------------------------ LOD [ ] Officer (give [ ] Other
(Last) (First) (Middle) title below) (specify below)
3399 Peachtree Road, N.E., Suite 2050 ---------------------------------------
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(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 value 1/1/99 (1) A V 1,231 A 4.875 353,950 (4) D
$.01 per share
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Common Stock, par value 4/1/99 (1) A V 1,231 A 4.4375 353,950 (4) D
$.01 per share
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Common Stock, par value 7/1/99 (1) A V 1,231 A 6.5625 353,950 (4) D
$.01 per share
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Common Stock, par value 10/1/99 (1) A V 1,231 A 3.75 353,950 (4) D
$.01 per share
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Common Stock, par value 12/1/99 (2) J (3) 992 A 6.125 353,950 (4) D
$.01 per share
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Common Stock, par value 12/1/99 (2) J (3) 6,124 A 6.125 353,950 (4) D,I By joint
$.01 per share title with
Spouse
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Common Stock, par value 12/1/99 (2) J (3) 15,794 A 6.125 353,950 (4) I By P.T.
$.01 per share Partners,
LLC, of
which the
Reporting
Person is
Manager.
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Common Stock, par value 12/29/99 G 8,040 D 353,950 (4) D
$.01 per share
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Common Stock, par value 12/29/99 G 8,040 A 353,950 (4) I By Trust for
$.01 per share benefit of
children
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Common Stock, par value 1/6/2000 G V 8,142 D 353,950 (4) D
$.01 per share
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Common Stock, par value 1/6/2000 G V 8,142 A 353,950 (4) I By Trust for
$.01 per share benefit of
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 1475 (3-99)
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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:
(1) Date represents the date of grant by the issuer. The certificates for these
shares were received December 17, 1999. The Reporting Person voluntarily reports
the acquisition of these shares earlier than required pursuant to Rule
16a-4(g)(2) under the Securities Exchange Act of 1934, as amended.
(2) Date represents the average date of receipt for all shares issued out of
escrow to the Reporting Person or his affiliates, including P.T. Partners, LLC,
of which the Reporting Person is sole member and manager. These shares were
mailed April 12, 1999 via first class United States mail.
(3) Shares acquired represent the portion of shares issued, but held in escrow,
pursuant to the merger of Impac Hotel Group, LLC and Servico, Inc. on December
11, 1998 (the "Merger"), and which were released from escrow after the
completion of certain hotels. The certificates representing these shares are
dated October 28, 1999, but were received by the Reporting Person and his
affiliates on or about December 1, 1999 and are therefore reported currently.
(4) 117,842 shares are owned directly. This figure includes 7,116 shares
released from escrow, 4,924 shares received from the issuer pursuant to director
compensation, and total distributions to trusts for the benefit of the Reporting
Person's children of 16,182 shares, all of which are reported on this Form.
236,108 shares are owned indirectly, including 15,794 shares released from
escrow and 16,182 shares contributed to trusts for the benefit of the Reporting
Person's children. According to the relationship previously reported on the
Reporting Person's Form 3 Initial Statement of Beneficial Ownership of
Securities, the Reporting Person may be deemed to be the beneficial owner of
15,794 shares received from escrow by P.T. Partners LLC.
** Intentional misstatements or omissions of
facts constitute Federal Criminal Violations.
See 18 U.S.C. and 15 U.S.C. 78ff(a). By: /S/ John M. Lang January 6, 2000
-------------------------------------- ---------------------------
** 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 1475 (3-99)
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