U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 5
ANNUAL 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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[_] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations
may continue. See Instruction 1(b).
[_] Form 3 Holdings Reported
[X] Form 4 Transactions Reported
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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)
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2. Issuer Name and Ticker or Trading Symbol
Lodgian, Inc./LOD
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Statement for Month/Year
7/00
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[_] Director [X] 10% Owner
[_] Officer (give title below) [_] Other (specify below)
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7. Individual or Joint/Group Filing
(Check applicable line)
[_] Form filed by one Reporting Person
[X] Form filed by more than one Reporting Person
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Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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<TABLE>
<CAPTION>
5. 6.
4. Amount of Owner-
Securities Acquired (A) or Securities ship
Disposed of (D) Beneficially Form: 7.
(Instr. 3, 4 and 5) Owned at End Direct Nature of
2. 3. ----------------------------- of Issuer's (D) or Indirect
1. Transaction Transaction (A) Fiscal Year Indirect Beneficial
Title of Security Date Code Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (Instr. 8) (D) and 4) (Instr.4) (Instr. 4)
(Month/
Day/
Year)
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<S> <C> <C> <C> <C> <C> <C> <C> <C>
Common Stock, par value 5/25/00 P 1,100,000 A $2.00 4,191,800 (1) (1)
$0.01 per share
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</TABLE>
* 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 informa-
tion contained in this form are not required to respond unless the
form displays a currently valid OMB control number.
(Over)
SEC 2270 (3-99)
Page 1 of 3
<PAGE>
FORM 5 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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<TABLE>
<CAPTION>
9. 10.
Number Owner-
of ship
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- Securities Date Securities Price Bene- ity: In-
cise 3. Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- 4. or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Trans- of (D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date action (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ Code 4 and 5) Date Expira- Number ity Year (I) ship
Security Secur- Day/ (Instr. ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) 8) (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
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None.
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</TABLE>
Explanation of Responses: (1) Casuarina Cayman Holdings Ltd. ("Casuarina")
directly owns 1,593,700 shares of Lodgian, Inc. 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 1,593,700 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 July 24, 2000
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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 provided is insufficient, see Instruction 6 for procedure.
Potential persons who are to respond to the collection of informa tion contained
in this form are not required to respond unless the form displays a currently
valid OMB control number.
Page 2 of 3
SEC 1474 (9-96)
<PAGE>
Joint Filer Information
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Designated Filer: Casuarina Cayman Holdings Ltd.
Issuer and Ticker Symbol: Lodgian, Inc./LOD
Statement of Month/Year: 7/00
<TABLE>
<CAPTION>
Listing of Names and Addresses Signatures of Other
of Other Reporting Persons Reporting Persons Date
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<S> <C> <C>
Edgecliff Holdings, LLC EDGECLIFF HOLDINGS, LLC
207 Grandview Drive
Fort Mitchell, KY 41017 By: /s/ William J. Yung 7/24/00
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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 7/24/00
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Name: William J. Yung
Title: President
1994 William J. Yung Family Trust 1994 WILLIAM J. YUNG FAMILY TRUST
207 Grandview Drive
Fort Mitchell, KY 41017 By: The Fifth Third Bank, as Trustee
By: /s/ Robert Erickson 7/24/00
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Name: Robert Erickson
Title: Trust Officer
Joseph Yung /s/ Joseph Yung 7/24/00
207 Grandview Drive ------------------------------ -------
Fort Mitchell, KY 41017 Joseph Yung
William J. Yung
William J. Yung /s/ William J. Yung 7/24/00
1200 Cypress Street ------------------------------ -------
Cincinnati, OH 45206 William J. Yung
The 1998 William J. Yung 1998 WILLIAM J. YUNG AND
and Martha A. Yung Family Trust MARTHA A. YUNG FAMILY TRUST
207 Grandview Drive
Fort Mitchell, KY 41017 By: The Fifth Third Bank, as Trustee
By: /s/ Robert Erickson 7/24/00
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Name: Robert Erickson
Title: Trust Officer
</TABLE>
Page 2 of 3
