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
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
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
Remaning Holdings Exercise Date Expiration Date Equity Swap Involved Transaction Form Type Transaction Code Nature of Ownership
0 No 4 C Indirect
0 No 4 C Indirect
0 No 4 C Indirect
Footnotes
  1. 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)
  2. and (h) 83,160 shares of common stock held by Originate #1Q.
  3. 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.
  4. 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.