13D Filing: Coliseum Capital and Bioscrip Inc. (BIOS)

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Page 6 of 10 – SEC Filing


CUSIP No. 09069N108 (Common Stock)

  1.

Names of
Reporting Persons.

Adam Gray

  2.

Check the Appropriate Box if a Member
of a Group (See Instructions)

(a)  ☐        (b)  ☒

  3.

SEC Use Only

  4.

Source of Funds (See Instructions)

AF

  5.

Check if Disclosure of Legal
Proceedings Is Required Pursuant to Items 2(d) or 2(e)

  6.

Citizenship or Place of
Organization

United States

Number of

Shares

Beneficially

Owned by

Each

Reporting

Person

With

  7.

Sole Voting Power

0

  8.

Shared Voting Power

24,208,030 (1)

  9.

Sole Dispositive Power

0

10.

Shared Dispositive Power

24,208,030 (1)

11.

Aggregate Amount Beneficially Owned by Each Reporting Person

24,208,030 (1)

12.

Check if the Aggregate Amount in Row
(11) Excludes Certain Shares (See Instructions)

13.

Percent of Class Represented by
Amount in Row (11)

16.5% (1)

14.

Type of Reporting Person (See
Instructions)

IN

(1) Includes (a) 4,735,932 Common Shares, (b) 274,854 Common Shares that could be obtained upon conversion of 10,823 shares of Series A Convertible Preferred Stock, (c) 15,597,245 Common Shares that could be obtained
upon conversion of 614,177 shares of Series C Convertible Preferred Stock, (d) 1,800,000 Common Shares that could be obtained upon conversion of 1,800,000 Class A Warrants, and (e) 1,800,000 Common Shares that could be obtained upon conversion
of 1,800,000 Class B Warrants.

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