0001104659-16-147224.txt : 20160928 0001104659-16-147224.hdr.sgml : 20160928 20160928195440 ACCESSION NUMBER: 0001104659-16-147224 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160928 FILED AS OF DATE: 20160928 DATE AS OF CHANGE: 20160928 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Tabula Rasa HealthCare, Inc. CENTRAL INDEX KEY: 0001651561 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389] IRS NUMBER: 465726437 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 228 STRAWBRIDGE DRIVE STREET 2: SUITE 100 CITY: MOORESTOWN STATE: NJ ZIP: 08057 BUSINESS PHONE: 866-648-2767 MAIL ADDRESS: STREET 1: 228 STRAWBRIDGE DRIVE STREET 2: SUITE 100 CITY: MOORESTOWN STATE: NJ ZIP: 08057 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Davis Jordan CENTRAL INDEX KEY: 0001328592 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37888 FILM NUMBER: 161908122 MAIL ADDRESS: STREET 1: C/O AMERICAN BANK NOTE HOLOGRAPHICS, INC STREET 2: 399 EXECUTIVE BOULEVARD CITY: ELMSFORD STATE: NY ZIP: 10523 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Radius Venture Partners III (OHIO), LP CENTRAL INDEX KEY: 0001654645 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37888 FILM NUMBER: 161908123 BUSINESS ADDRESS: STREET 1: 400 MADISON AVE. STREET 2: 8TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10017 BUSINESS PHONE: 6123555202 MAIL ADDRESS: STREET 1: 1331 TYLER STREET NE STREET 2: SUITE 200 CITY: MINNEAPOLIS STATE: MN ZIP: 55413 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Radius Venture Partners III QP, L.P. CENTRAL INDEX KEY: 0001402778 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37888 FILM NUMBER: 161908124 BUSINESS ADDRESS: STREET 1: 400 MADISON AVENUE STREET 2: 8TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10017 BUSINESS PHONE: 212-897-7778 MAIL ADDRESS: STREET 1: 400 MADISON AVENUE STREET 2: 8TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10017 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: RADIUS VENTURE PARTNERS III L P CENTRAL INDEX KEY: 0001386468 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37888 FILM NUMBER: 161908125 BUSINESS ADDRESS: STREET 1: 400 MADISON AVE 8TH FL CITY: NEW YORK STATE: NY ZIP: 10017 BUSINESS PHONE: 212-897-7778 MAIL ADDRESS: STREET 1: 400 MADISON AVE 8TH FL CITY: NEW YORK STATE: NY ZIP: 10017 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Radius Venture Partners III, LLC CENTRAL INDEX KEY: 0001402970 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37888 FILM NUMBER: 161908126 BUSINESS ADDRESS: STREET 1: 400 MADISON AVENUE STREET 2: 8TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10017 BUSINESS PHONE: 212-897-7778 MAIL ADDRESS: STREET 1: 400 MADISON AVENUE STREET 2: 8TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10017 3 1 a3.xml 3 X0206 3 2016-09-28 0 0001651561 Tabula Rasa HealthCare, Inc. TRHC 0001402970 Radius Venture Partners III, LLC 250 PARK AVENUE, SUITE 1102 NEW YORK NY 10177 0 0 1 0 0001386468 RADIUS VENTURE PARTNERS III L P 250 PARK AVENUE, SUITE 1102 NEW YORK NY 10177 0 0 1 0 0001402778 Radius Venture Partners III QP, L.P. 250 PARK AVENUE, SUITE 1102 NEW YORK NY 10177 0 0 1 0 0001654645 Radius Venture Partners III (OHIO), LP 250 PARK AVENUE, SUITE 1102 NEW YORK NY 10177 0 0 1 0 0001328592 Davis Jordan 250 PARK AVENUE, SUITE 1102 NEW YORK NY 10177 0 0 1 0 Common Stock 36811 I By Radius Venture Partners III (Ohio), L.P. Common Stock 293100 I By Radius Venture Partners III QP, L.P. Common Stock 26879 I Radius Venture Partners III, L.P. Series A-1 Preferred Stock Common Stock 29346 I By Radius Venture Partners III (Ohio), L.P. Series A-1 Preferred Stock Common Stock 233659 I By Radius Venture Partners III QP, L.P. Series A-1 Preferred Stock Common Stock 21428 I Radius Venture Partners III, L.P. Series B Preferred Stock Common Stock 270952 I By Radius Venture Partners III (Ohio), L.P. Series B Preferred Stock Common Stock 2157390 I By Radius Venture Partners III QP, L.P. Series B Preferred Stock Common Stock 197846 I Radius Venture Partners III, L.P. These securities are held directly by Radius Venture Partners III (Ohio), L.P. and indirectly by Radius Venture Partners III, LLC, the general partner of Radius Venture Partners III (Ohio), L.P., Jordan S. Davis, managing member of Radius Venture Partners III, LLC, and Daniel C. Lubin, managing member of Radius Venture Partners III, LLC. Mr. Lubin and Mr. Davis share voting and dispositive power with respect to the shares held by Radius Venture Partners III (Ohio), L.P. Mr. Lubin is a director of the Issuer and files separate Section 16 reports. Each of Radius Venture Partners III, LLC, Mr. Davis, and Mr. Lubin may be deemed to beneficially own such securities, and disclaims such beneficial ownership except to the extent of its or his pecuniary interest therein. These securities are held directly by Radius Venture Partners III QP, L.P and indirectly by Radius Venture Partners III, LLC, the general partner of Radius Venture Partners III (Ohio), L.P., Jordan S. Davis, managing member of Radius Venture Partners III, LLC, and Daniel C. Lubin, managing member of Radius Venture Partners III, LLC. Mr. Lubin and Mr. Davis share voting and dispositive power with respect to the shares held by Radius Venture Partners III QP, L.P. Mr. Lubin is a director of the Issuer and files separate Section 16 reports. Each of Radius Venture Partners III, LLC, Mr. Davis, and Mr. Lubin may be deemed to beneficially own such securities, and disclaims such beneficial ownership except to the extent of its or his pecuniary interest therein. These securities are held directly by Radius Venture Partners III, L.P., and indirectly by Radius Venture Partners III, LLC, the general partner of Radius Venture Partners III, L.P., Jordan S. Davis, managing member of Radius Venture Partners III, LLC, and Daniel C. Lubin, managing member of Radius Venture Partners III, LLC. Mr. Lubin and Mr. Davis share voting and dispositive power with respect to the shares held by Radius Venture Partners III, L.P. Mr. Lubin is a director of the Issuer and files separate Section 16 reports. Each of Radius Venture Partners III, LLC, Mr. Davis, and Mr. Lubin may be deemed to beneficially own such securities, and disclaims such beneficial ownership except to the extent of its or his pecuniary interest therein. Each share of Series A-1 Preferred Stock and Series B Preferred Stock will convert automatically into shares of Issuer's Common Stock immediately prior to the closing of the Issuer's initial public offering. The securities do not have an expiration date. RADIUS VENTURE PARTNERS III, LLC By: /s/ Daniel C. Lubin Managing Member 2016-09-28 RADIUS VENTURE PARTNERS III, L.P. By: Radius Venture Partners III, LLC, its General Partner By: /s/ Daniel C. Lubin Managing Member 2016-09-28 RADIUS VENTURE PARTNERS III QP, L.P. By: Radius Venture Partners III, LLC, its General Partner By: /s/ Daniel C. Lubin Managing Member 2016-09-28 RADIUS VENTURE PARTNERS (OHIO) III QP, L.P. By: Radius Venture Partners (Ohio) III, LLC, its General Partner By: Radius Venture Partners III, LLC, its sole member By: /s/ Daniel C. Lubin Managing Member 2016-09-28 /s/ Jordan S. Davis 2016-09-28