0001104659-16-148725.txt : 20161004
0001104659-16-148725.hdr.sgml : 20161004
20161004210251
ACCESSION NUMBER: 0001104659-16-148725
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20161004
FILED AS OF DATE: 20161004
DATE AS OF CHANGE: 20161004
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37888
FILM NUMBER: 161921230
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37888
FILM NUMBER: 161921231
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37888
FILM NUMBER: 161921232
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37888
FILM NUMBER: 161921233
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37888
FILM NUMBER: 161921234
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
4
1
a4.xml
4
X0306
4
2016-10-04
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
2016-10-04
4
C
0
154792
A
191603
I
By Radius Venture Partners III (Ohio), L.P.
Common Stock
2016-10-04
4
C
0
1232499
A
1525599
I
By Radius Venture Partners III QP, L.P.
Common Stock
2016-10-04
4
C
0
113027
A
139906
I
By Radius Venture Partners III, L.P.
Common Stock
2016-10-04
4
J
0
2102
0
D
189501
I
By Radius Venture Partners III (Ohio), L.P.
Common Stock
2016-10-04
4
J
0
16735
0
D
1508864
I
By Radius Venture Partners III QP, L.P.
Common Stock
2016-10-04
4
J
0
1535
0
D
138371
I
By Radius Venture Partners III, L.P.
Series A-1 Preferred Stock
2016-10-04
4
C
0
29346
D
Common Stock
15127
0
I
By Radius Venture Partners III (Ohio), L.P.
Series A-1 Preferred Stock
2016-10-04
4
C
0
233659
D
Common Stock
120443
0
I
By Radius Venture Partners III QP, L.P.
Series A-1 Preferred Stock
2016-10-04
4
C
0
21428
D
Common Stock
11045
0
I
By Radius Venture Partners III, L.P.
Series B Preferred Stock
2016-10-04
4
C
0
270952
D
Common Stock
139665
0
I
By Radius Venture Partners III (Ohio), L.P.
Series B Preferred Stock
2016-10-04
4
C
0
2157390
D
Common Stock
1112056
0
I
By Radius Venture Partners III QP, L.P.
Series B Preferred Stock
2016-10-04
4
C
0
197846
D
Common Stock
101982
0
I
By 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 QP, 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 was converted automatically into shares of the Issuer's Common Stock immediately prior to the closing of Issuer's initial public offering.
The securities did not have an expiration date.
20,372 shares of common stock were surrendered to the Issuer at the completion of Issuer's initial public offering pursuant to the letter agreement, dated as of June 30, 2014, as amended, with the Issuer.
RADIUS VENTURE PARTNERS III, LLC By: /s/ Daniel C. Lubin Managing Member
2016-10-04
RADIUS VENTURE PARTNERS III, L.P. By: Radius Venture Partners III, LLC, its General Partner By: /s/ Daniel C. Lubin Managing Member
2016-10-04
RADIUS VENTURE PARTNERS III QP, L.P. By: Radius Venture Partners III, LLC, its General Partner By: /s/ Daniel C. Lubin Managing Member
2016-10-04
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
2016-10-04
/s/ Jordan S. Davis
2016-10-04