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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)
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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)
Cole Robert S. Lodgian, Inc. LOD 02/00 [X] Director [ ] 10% Owner
------------------------------------ [X] Officer (give [ ] Other
(Last) (First) (Middle) title below) (specify below)
Chief Executive Officer
3445 Peachtree Road, N.E. Suite 700 ---------------------------------------
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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
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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 10/28/99 J(1) 43,932 A $6.125 687,672 D
par value $.01 per share
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Common Stock 02/16/00 J(2) 15,889 $6.125 687,672 D
par value $0.1 per share
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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)
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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) Shares 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, and which were released from escrow after the completion of certain hotels. The
Certificates representing these shares are dated March 12, 1999, but were received by the Reporting Person on October 28, 1999.
(2) Shares 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, and which were released from escrow after the completion of certain hotels. The
Certificates representing these shares are dated March 12, 1999, but were received by the Reporting Person on February 16,
2000.
** Intentional misstatements or omissions of
facts constitute Federal Criminal Violations.
See 18 U.S.C. and 15 U.S.C. 78ff(a). By: /s/ Robert S.Cole July 28, 2000
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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 1475 (3-99)
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