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Filing Details

Accession Number:: 0001192482-16-000722
Form Type:: 4
Zero Holdings:: No
Publication Time:: 2016-10-05 16:24:23
Reporting Period:: 2016-10-04

Filing Date:: 2016-10-05
Accepted Time:: 2016-10-05 16:24:23
SEC Url:: Form 4 Filing

Issuer

Cik	Name	Symbol	Sector (SIC)	IRS No
1651561	Tabula Rasa Healthcare Inc.	TRHC	()	4

Insiders

Cik	Name	Reported Address	Insider Title	Director	Officer	Large Shareholder	Other
1125761	J Michael Gausling	205 Webster Street Bethlehem PA 18015		No	No	Yes	No

Reported Non-Derivative Transactions

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Sec. Name	Acquisiton - Disposition	Date	Amount	Price	Remaning Holdings	Equity Swap Involved	Form Type	Code	Nature of Ownership	Explanation
Common Stock	Acquisiton	2016-10-04	1,516,070	$0.00	1,636,888	No	4	C	Indirect	By Originate Growth Fund #1A, L.P. and Originate Growth Fund #1Q, L.P.
Common Stock	Acquisiton	2016-10-04	971,012	$0.00	2,607,900	No	4	C	Indirect	By Originate Growth Fund #1A, L.P. and Originate Growth Fund #1Q, L.P.
Common Stock	Acquisiton	2016-10-04	172,967	$0.00	2,780,867	No	4	C	Indirect	By Originate Growth Fund #1A, L.P. and Originate Growth Fund #1Q, L.P.
Common Stock	Acquisiton	2016-10-04	8,000	$12.00	2,788,867	No	4	P	Direct

Equity Swap Involved	Form Type	Code	Nature of Ownership	Explanation
No	4	C	Indirect	By Originate Growth Fund #1A, L.P. and Originate Growth Fund #1Q, L.P.
No	4	C	Indirect	By Originate Growth Fund #1A, L.P. and Originate Growth Fund #1Q, L.P.
No	4	C	Indirect	By Originate Growth Fund #1A, L.P. and Originate Growth Fund #1Q, L.P.
No	4	P	Direct

Reported Derivative Transactions

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Sec. Name	Sec. Type	Acquisiton - Disposition	Date	Amount	Price	Amount - 2	Price - 2
Common Stock	Series A Preferred Stock	Disposition	2016-10-04	2,941,176	$0.00	1,516,070	$0.00
Common Stock	Series A-1 Preferred Stock	Disposition	2016-10-04	1,883,763	$0.00	971,012	$0.00
Common Stock	Series B Preferred Stock	Disposition	2016-10-04	335,557	$0.00	172,967	$0.00

Equity Swap Involved	Transaction Form Type	Transaction Code	Nature of Ownership
No	4	C	Indirect
No	4	C	Indirect
No	4	C	Indirect

Footnotes

The shares consist of (a) 472,560 shares of common stock issued upon the conversion of 916,766 shares of Series A preferred stock held by Originate Growth Fund #1A, L.P., ("Originate #1A"), (b) 1,043,510 shares of common stock issued upon the conversion of 2,024,410 shares of Series A preferred stock held by Originate Growth Fund #1Q, L.P., ("Originate #1Q"), (c) 302,659 shares of common stock issued upon the conversion of 587,158 shares of Series A-1 preferred stock held by Originate #1A, (d) 668,353 shares of common stock issued upon the conversion of 1,296,605 shares of Series A-1 preferred stock held by Originate #1Q, (e) 53,912 shares of common stock issued upon the conversion of 104,589 shares of Series B preferred stock held by Originate #1A, (f) 119,055 shares of common stock issued upon the conversion of 230,968 shares of Series B preferred stock held by Originate #1Q, (g) 37,658 shares of common stock held by Originate #1A, (CONTINUED IN FOOTNOTE 2)
and (h) 83,160 shares of common stock held by Originate #1Q.
The general partner of both Originate #1Q and Originate #1A is Originate GP, LLC, a limited liability company. The members of Originate GP, LLC are Glen Bressner, Eric Arnson, and Michael Gausling. The members of Originate GP share voting and dispositive power over the shares held by Originate #1Q and Originate #1A. Mr. Gausling disclaims beneficial ownership of such shares, except to the extent of his pecuniary interest.
All series of Preferred Stock automatically converted into Tabula Rasa HealthCare, Inc. (the "Issuer") common stock immediately prior to the closing of the initial public offering and have no expiration date.