AVISTA HEALTHCARE PUBLIC ACQUISITION CORP.
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(Name of Issuer)
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CLASS A ORDINARY SHARES, PAR VALUE $0.0001 PER SHARE
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(Title of Class of Securities)
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G0726L 125
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(CUSIP Number)
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DECEMBER 31, 2016
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(Date of Event Which Requires Filing of this Statement)
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☐
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Rule 13d-1(b)
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☐
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Rule 13d-1(c)
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☒
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Rule 13d-1(d)
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CUSIP No. G0726L 125
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13G
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Page 2 of 10
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1
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NAMES OF REPORTING PERSONS
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AVISTA ACQUISITION CORP.
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (SEE INSTRUCTIONS)
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(a)☒
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(b)☐
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3
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SEC USE ONLY
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4
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CITIZENSHIP OR PLACE OF ORGANIZATION
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Cayman Islands
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NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH
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5
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SOLE VOTING POWER
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0
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6
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SHARED VOTING POWER
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5,878,820 (1)
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7
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SOLE DISPOSITIVE POWER
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0
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8
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SHARED DISPOSITIVE POWER
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5,878,820 (1)
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9
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
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5,878,820 (1)
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10
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CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS)
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☒
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11
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PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)
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15.9%(2)
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12
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TYPE OF REPORTING PERSON (SEE INSTRUCTIONS)
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CO
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CUSIP No. G0726L 125
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13G
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Page 3 of 10
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1
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NAMES OF REPORTING PERSONS
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AVISTA ACQUISITION, LLC
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (SEE INSTRUCTIONS)
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||||
(a)☒
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(b)☐
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3
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SEC USE ONLY
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4
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CITIZENSHIP OR PLACE OF ORGANIZATION
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DELAWARE
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NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH
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5
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SOLE VOTING POWER
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0
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6
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SHARED VOTING POWER
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5,878,820 (3)
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7
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SOLE DISPOSITIVE POWER
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0
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8
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SHARED DISPOSITIVE POWER
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5,878,820 (3)
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9
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
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5,878,820 (3)
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|||
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||||
10
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CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS)
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☒
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11
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PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)
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15.9%(4)
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12
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TYPE OF REPORTING PERSON (SEE INSTRUCTIONS)
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OO
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CUSIP No. G0726L 125
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13G
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Page 4 of 10
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1
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NAMES OF REPORTING PERSONS
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THOMPSON DEAN
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (SEE INSTRUCTIONS)
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(a)☒
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(b)☐
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3
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SEC USE ONLY
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4
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CITIZENSHIP OR PLACE OF ORGANIZATION
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DELAWARE
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NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH
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5
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SOLE VOTING POWER
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0
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||||
6
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SHARED VOTING POWER
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5,878,820 (5)
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7
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SOLE DISPOSITIVE POWER
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0
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|||
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||||
8
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SHARED DISPOSITIVE POWER
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5,878,820 (5)
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|||
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||||
9
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
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5,878,820 (5)
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|||
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|
||||
10
|
CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS)
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|
||
☒
|
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|||
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|
||||
11
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PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)
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15.9% (6)
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||||
12
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TYPE OF REPORTING PERSON (SEE INSTRUCTIONS)
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IN
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CUSIP No. G0726L 125
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13G
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Page 5 of 10
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1
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NAMES OF REPORTING PERSONS
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DAVID BURGSTAHLER
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (SEE INSTRUCTIONS)
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||||
(a)☒
|
|||||
(b)☐
|
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|||
3
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SEC USE ONLY
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|||
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4
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CITIZENSHIP OR PLACE OF ORGANIZATION
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UNITED STATES
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NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH
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5
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SOLE VOTING POWER
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0
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|||
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||||
6
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SHARED VOTING POWER
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5,878,820 (7)
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||||
7
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SOLE DISPOSITIVE POWER
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0
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|||
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||||
8
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SHARED DISPOSITIVE POWER
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5,878,820 (7)
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|||
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||||
9
|
AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
|
|
|
||
5,878,820 (7)
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|
|
|||
|
|
||||
10
|
CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS)
|
|
|
||
☒
|
|
|
|||
|
|
||||
11
|
PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)
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|
|
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15.9% (8)
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|
|||
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|
||||
12
|
TYPE OF REPORTING PERSON (SEE INSTRUCTIONS)
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IN
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Item 1(a). |
Name of Issuer
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Item 1(b). |
Address of Issuer’s Principal Executive Offices
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Item 2. |
(a) Name of Person Filing
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Item 3. |
If this statement is filed pursuant to §§240.13d-1(b) or 240.13d-2(b) or (c), check whether the person filing is a:
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☐
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Broker or dealer registered under section 15 of the Act (15 U.S.C. 78o);
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☐
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Bank as defined in section 3(a)(6) of the Act (15 U.S.C. 78c);
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☐
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Insurance company as defined in section 3(a)(19) of the Act (15 U.S.C. 78c);
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☐
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Investment company registered under section 8 of the Investment Company Act of 1940 (15 U.S.C. 80a-8);
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☐
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An investment adviser in accordance with §240.13d-1(b)(1)(ii)(E);
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☐
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An employee benefit plan or endowment fund in accordance with §240.13d-1(b)(1)(ii)(F);
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☐
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A parent holding company or control person in accordance with §240.13d-1(b)(1)(ii)(G);
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☐
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A savings associations as defined in Section 3(b) of the Federal Deposit Insurance Act (12 U.S.C. 1813);
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☐
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A church plan that is excluded from the definition of an investment company under section 3(c)(14) of the Investment Company Act of 1940 (15 U.S.C. 80a-3);
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☐
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A non-U.S. institution in accordance with §240.13d-1(b)(1)(ii)(J);
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☐
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A group, in accordance with §240.13d-1(b)(1)(ii)(K). If filing as a non-U.S. institution in accordance with §240.13d-1(b)(1)(ii)(J), please specify the type of institution:
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Item 4. |
Ownership
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(a)
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Amount beneficially owned:(*)
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(b)
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Percent of class:
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(c)
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Number of shares as to which such person has:(*)
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Item 5. |
Ownership of Five Percent or Less of a Class
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Item 6. |
Ownership of More than Five Percent on Behalf of Another Person
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Item 7. |
Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on by the Parent Holding Company or Control Person
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Item 8. |
Identification and Classification of Members of the Group
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Item 9.
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Notice of Dissolution of Group
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Item 10.
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Certifications
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AVISTA ACQUISITION CORP.
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By:
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/s/ Benjamin Silbert | |
Benjamin Silbert, Attorney-in-Fact
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AVISTA ACQUISITION, LLC
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By:
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/s/ Benjamin Silbert
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Benjamin Silbert, Attorney-in-Fact
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THOMPSON DEAN
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By:
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/s/ Benjamin Silbert
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Benjamin Silbert, Attorney-in-Fact
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DAVID BURGSTAHLER
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By:
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/s/ Benjamin Silbert
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Benjamin Silbert, Attorney-in-Fact
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Exhibit No.
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Joint Filing Agreement, dated February 3, 2017, among Avista Acquisition Corp., Avista Acquisition, LLC, Thompson Dean and David Burgstahler.
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2
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Power of Attorney previously filed as Exhibit 24.1 to a Form 3 with regard to Avista Healthcare Public Acquisition Corp. filed with the Securities and Exchange Commission on October 7, 2016 by Avista Acquisition Corp., Avista Acquisition, LLC, Thompson Dean and David Burgstahler.
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3
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Power of Attorney previously filed as Exhibit 24.2 to a Form 3 with regard to Avista Healthcare Public Acquisition Corp. filed with the Securities and Exchange Commission on October 7, 2016 by Avista Acquisition Corp., Avista Acquisition, LLC, Thompson Dean and David Burgstahler.
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AVISTA ACQUISITION CORP.
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|||
By:
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/s/ Benjamin Silbert
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Benjamin Silbert, Attorney-in Fact for
Avista Acquisition Corp. (1)
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AVISTA ACQUISITION, LLC
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By:
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/s/ Benjamin Silbert
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Benjamin Silbert, Attorney-in Fact for
Avista Acquisition, LLC (2)
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THOMPSON DEAN
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/s/ Benjamin Silbert
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By:
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Benjamin Silbert, Attorney-in-Fact for
Thompson Dean (3)
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DAVID BURGSTAHLER
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/s/ Benjamin Silbert
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By:
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/s/ Benjamin Silbert, Attorney-in-Fact
for David Burgstahler (4)
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