<TABLE>
- ------------------------- ------------------------------
FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION OMB Approval
- ------------------------- Washington, D.C. 20549 ------------------------------
[ ] Check this box if no OMB Number: 3235-0362
longer subject to Expires: December 31, 2001
Section 16. Form 4 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Estimated average burden
or Form 5 obligations hours per response.......1.0
may continue. See ------------------------------
Instruction 1(b). Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934,
[ ] Form 3 Holdings Section 17(a) of the Public Utility Holding Company Act of 1935 or
Reported Section 30(f) of the Investment Company Act of 1940
[ ] Form 4 Transactions
Reported
<CAPTION>
- --------------------------------------------------- ------------------------------------------------------ -------------------------
1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person(s)
to Issuer (Check all applicable)
Lodgian, Inc. LOD
Calabro Joseph C. [X] Director [ ] 10% Owner
- ---------------------------------------------------------------------------------------- [ ] Officer (give [ ] Other (specify
(Last) (First) (Middle) 3. IRS or Social 4. Statement for title below)
Security Number of Month/Year below)
Reporting Person
c/o Lodgian, Inc. (Voluntary) 12/99
3445 Peachtree Road, N.E., Suite 700 ------------------------------------
- ------------------------------------------ ---------------------------------------------------------------
(Street) 5. If Amendment, 7. Individual or Joint/Group Reporting
Date of Original (check applicable line)
(Month/Year) [X] Form Filed by One Reporting Person
[ ] Form Filed by More than One Reporting
Atlanta GA 30326 Person
- ------------------------------------------------------------------------------------------------------------------------------------
(City) (State) (Zip)
TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
<S> <C> <C> <C> <C> <C> <C>
- ------------------------------------------------------------------------------------------------------------------------------------
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 Issuer's (I) (Instr. 4)
Year) Fiscal Year (Instr. 4)
(Instr. 3
and 4)
- ------------------------------------------------------------------------------------------------------------------------------------
Amount (A) or (D) Price
- ------------------------------------------------------------------------------------------------------------------------------------
Common Stock, par value 01/01/99(1) A 2,565 A 4.875 216,360 D
$.01 per share
- ------------------------------------------------------------------------------------------------------------------------------------
Common Stock, par value 04/01/99(1) A 2,565 A 4.4375 216,360 D
$.01 per share
- ------------------------------------------------------------------------------------------------------------------------------------
Common Stock, par value 07/01/99(1) A 2,565 A 6.5625 216,360 D
$.01 per share
- ------------------------------------------------------------------------------------------------------------------------------------
Common Stock, par value 10/01/99(1) A 2,565 A 3.75 216,360 D
$.01 per share
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
Page 1 of 2
SEC 2270 (3-99)
</TABLE>
<PAGE>
<TABLE>
<CAPTION>
FORM 5 (continued)
TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(e.g., puts, calls, warrants, options, convertible securities)
<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
- ------------------------------------------------------------------------------------------------------------------------------------
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.
Year 4)
(Instr.
4)
---------------------------------------------------
(A) (D) Date Expir- Title Amount
Exerci- ation or
sable Date Number
of
Shares
---------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
Option to $6.50 06/25/99 A 5,000 06/25/99 06/25/09 Common 5,000 60,000 D
Purchase Stock
Common Stock,
par value
$.01/share
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
- ------------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses:
** 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 /s/ Joseph C. Calabro February 10, 2000
signed. If space is insufficient, see Instruction 6 for ------------------------------------ --------------------
procedure. ** Signature of Reporting Person Date
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 control number.
Page 2 of 2
SEC 2270 (3-99)
</TABLE>
