SEC FORM
4
SEC Form 4
| FORM 4 |
UNITED STATES 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
or Section 30(h) of the Investment Company Act of 1940
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| OMB APPROVAL |
| OMB Number: |
3235-0287 |
| Estimated average burden |
| hours per response: |
0.5 |
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|
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b). |
1. Name and Address of Reporting Person*
| C/O BIOSCRIP INC. |
| 100 CLEARBROOK ROAD |
(Street)
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2. Issuer Name and Ticker or Trading Symbol
BioScrip, Inc.
[ BIOS ]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
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10% Owner |
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Officer (give title below) |
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Other (specify below) |
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3. Date of Earliest Transaction
(Month/Day/Year)
08/18/2015
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4. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
| X |
Form filed by One Reporting Person |
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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 (Instr.
3)
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2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction Code (Instr.
8)
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4. Securities Acquired (A) or Disposed Of (D) (Instr.
3, 4 and 5)
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5.
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr.
3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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7. Nature of Indirect Beneficial Ownership (Instr.
4)
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| Code |
V |
Amount |
(A) or (D) |
Price |
| Common Stock, $.0001 Par Value |
08/18/2015 |
|
P |
|
20,000 |
A |
$1.541
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30,000 |
D |
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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|---|
| 1. Title of Derivative Security (Instr.
3)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction Code (Instr.
8)
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5.
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
3, 4 and 5)
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6. Date Exercisable and Expiration Date
(Month/Day/Year) |
7. Title and Amount of Securities Underlying Derivative Security (Instr.
3 and 4)
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8. Price of Derivative Security (Instr.
5)
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9.
Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
4)
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10. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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11. Nature of Indirect Beneficial Ownership (Instr.
4)
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| Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Explanation of Responses: |
|
|
/s/ Caroline Fox, attorney-in-fact for Mr Golding |
08/19/2015 |
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** Signature of Reporting Person |
Date |
| 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). |
| ** 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 is insufficient,
see
Instruction 6 for procedure. |
| Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |
EXHIBIT 24
LIMITED POWER OF ATTORNEY FOR
SECTION 16 REPORTING OBLIGATIONS
Know all by these presents, that the undersigned hereby makes,
constitutes and appoints each of Kimberlee C. Seah, Caroline Fox
and Eric Wu, or any of them, each acting individually, as the
undersigned's true and lawful attorney-in-fact, with full power
and authority as hereinafter described on behalf of and in the
name, place and stead of the undersigned, in the undersigned?s
capacity as an officer and/or director of BioScrip, Inc., a
Delaware corporation (the "Company"), to:
1. prepare, execute, acknowledge, deliver and file in the
undersigned's name and on the undersigned's behalf, and submit to
the United States Securities and Exchange Commission (the "SEC"),
a Form ID (including any amendments thereto) and any other documents
necessary or appropriate to obtain codes and passwords for the
undersigned to make electronic filings with the SEC of reports
required by Section 16(a) of the Securities Exchange Act of 1934
and the rules and regulations promulgated thereunder, as amended
from time to time (the "Exchange Act");
2. prepare, execute, acknowledge, deliver and file Forms 3, 4 and 5
(including any amendments thereto) with respect to the securities
of the Company required to be filed with the SEC, any national
securities exchanges and the Company pursuant to Section 16(a) of
the Exchange Act;
3. seek or obtain, as the undersigned's representative and on the
undersigned's behalf, information on transactions in the Company's
securities from any third party, including brokers, employee
benefit plan administrators and trustees, and the undersigned
hereby authorizes any such person to release any such information
to the undersigned and approves and ratifies any such release of
information; and
4. take any other action of any type whatsoever in connection
with the foregoing which, in the opinion of such attorney-in-fact,
may be of benefit to, in the best interest of, or legally required
by, the undersigned in connection with the foregoing.
The undersigned acknowledges that:
i) This Limited Power of Attorney authorizes, but does not require,
each such attorney-in-fact to act in their discretion on information
provided to such attorney-in-fact without independent verification
of such information.
ii) Any documents prepared and/or executed by either of such attorneys-
in-fact on behalf of the undersigned pursuant to this Limited Power
of Attorney will be in such form and will contain such information
and disclosure as such attorney-in-fact, in his or her discretion,
deems necessary or desirable.
iii) Neither the Company nor either of such attorneys-in-fact
assumes (A) any liability for the undersigned's responsibility to
comply with the requirement of the Exchange Act, (B) any liability
of the Undersigned for any failure to comply with such requirements,
or (C) any obligation or liability of the undersigned for profit
disgorgement under Section 16(b) of the Exchange Act.
iv) This Limited Power of Attorney does not relieve the undersigned
from responsibility for compliance with the undersigned's obligations
under the Exchange Act, including without limitation the reporting
requirements under Section 16 of the Exchange Act.
The undersigned hereby gives and grants each of the foregoing
attorneys-in-fact full power and authority to do and perform all and
every act and thing whatsoever requisite, necessary or appropriate to
be done in and about the foregoing matters as fully to all intents and
purposes as the undersigned might or could do if present, hereby
ratifying all that each such attorney-in-fact of, for and on behalf of
the undersigned, shall lawfully do or cause to be done by virtue of this
Limited Power of Attorney.
This Limited Power of Attorney supersedes any power of attorney
previously executed by the undersigned regarding the purposes outlined
in the first paragraph hereof ("Prior Powers of Attorney"), and the
authority of the attorneys-in-fact named in any Prior Powers of Attorney
is hereby revoked.
This Limited Power of Attorney shall remain in full force and
effect until the undersigned is no longer required to file Forms 3, 4
and 5 with respect to the undersigned's holdings and transactions
in securities issued by the Company, unless earlier revoked by the
undersigned in a signed writing delivered to each such attorney-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of
Attorney to be executed as of this 11th day of May, 2015.
By: /s/ David W. Golding
David Golding
