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U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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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FORM 4 OMB APPROVAL
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[ ] CHECK THIS BOX IF NO LONGER OMB Number: 3235-0287
SUBJECT TO SECTION 16. FORM 4 Expires: December 31, 2001
OR FORM 5 OBLIGATIONS MAY Estimated average burden
CONTINUE. SEE INSTRUCTION 1(B). hours per response .... 0.5
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1. Name and Address of Reporting Person *
Casuarina Cayman Holdings Ltd.
(Last) (First) (Middle)
207 Grandview Drive
(Street)
Fort Mitchell KY 41017
(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Lodgian, Inc./LOD
3. IRS or Social Security Number of Reporting Person (Voluntary)
4. Statement of Month/Year
12/99
5. If Amendment, Date or Original (Month/Year)
6. Relationship of Reporting Person to Issuer (Check all applicable)
Director X 10% Owner
----- -----
Officer (give title Other
----- below) ----- (specify
below)
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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 ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
1. Title of Security 2. Transaction 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7. Nature
(Instr. 3) Date action or Disposed of (D) Securities ship of In-
Code (Instr. 3, 4 and 5) Beneficially Form: direct
(Month/ (Instr. 8) Owned at Direct Bene-
Day/ ------------- ------------------------- End of (D) ficial
Year) (A) Month Indirect Owner-
Code V Amount or Price (Instr. 3 (I) ship
(D) and 4) (Instr. 4) (Instr. 4)
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Common Stock, par value $0.01
per share 12/29/99 P 34,000 A $5.00 2,975,700 (1) (1)
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Page 1 of 3
Reminder: Report on a separate line for each class of (Over)
securities beneficially owned directly or indirectly. SEC 1474 (3-99)
* If the form is filed by more than one reporting person, see Instruction
4(b)(v).
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.
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FORM 4 (continued) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
1. Title of Derivative 2. Conver- 3. Trans- 4. Transac- 5. Number of Deriv- 6. Date Exer-
Security (Instr. 3) sion or action tion Code ative Securities Ac- cisable and Ex-
Exercise Date (Instr. 8) quired (A) or Dis- piration Date
Price of posed of (D)
Deriv- (Month/ (Instr. 3, 4 and 5) (Month/Day/
ative Day/ Year)
Security Year) ------------- ------------------------- ----------------------
Date Expira-
Code V (A) (D) Exer- tion
cisable Date
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None.
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7. Title and Amount of 8. Price 9. Number 10. Owner- 11. Na-
Underlying Securities Deriv of Deriv- ship ture
ative ative Form of In-
(Instr. 3 and 4) Secur- Secur- of De- direct
ity ities rivative Bene-
(Instr. Bene Secu- ficial
5) ficially rity: Own-
Owned Direct ership
- -------------------------------------- at End (D) or (Instr. 4)
Amount or of Indi-
Title Number of Month rect (I)
Shares (Instr. 4) (Instr. 4)
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Explanation of Responses: (1) Casuarina Cayman Holdings Ltd. ("Casuarina")
directly owns 377,600 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 377,600 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 dispositive 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 January 5, 2000
------------------------------- -------------------
**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 provided 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.
Page 2 of 3
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Joint Filer Information
Designated Filer: Casuarina Cayman Holdings Ltd.
Issuer and Ticker Symbol: Lodgian, Inc./LOD
Statement of Month/Year: 12/99
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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 1/5/00
-------------------
Name: William J. Yung
Title: President
Edgecliff Management, LLC EDGECLIFF MANAGEMENT, LLC
207 Grandview Drive
Fort Mitchell, KY 41017 By: /s/ William J. Yung 1/5/00
-------------------
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 1/5/00
----------------------
Name: Timothy A. Rodgers
Title: Trust Officer
Joseph Yung /s/ Joseph Yung 1/5/00
207 Grandview Drive ---------------
Fort Mitchell, KY 41017 Joseph Yung
William J. Yung /s/ William J. Yung 1/5/00
1200 Cypress Street -------------------
Cincinnati, OH 45206 William J. Yung
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 1/5/00
----------------------
Name: Timothy A. Rodgers
Title: Trust Officer
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