0001179110-18-002651.txt : 20180222 0001179110-18-002651.hdr.sgml : 20180222 20180222192056 ACCESSION NUMBER: 0001179110-18-002651 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180122 FILED AS OF DATE: 20180222 DATE AS OF CHANGE: 20180222 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LUBIN DANIEL C CENTRAL INDEX KEY: 0001335280 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37888 FILM NUMBER: 18634252 MAIL ADDRESS: STREET 1: RADIUS VENTURE PARTNERS II LLC STREET 2: 400 MADISON AVE 8TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10017 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 4 1 edgar.xml FORM 4 - X0306 4 2018-01-22 1 0001651561 Tabula Rasa HealthCare, Inc. TRHC 0001335280 LUBIN DANIEL C 250 PARK AVENUE SUITE 1102 NEW YORK NY 10177 0 0 0 1 Former Director Common Stock 121717 I By Radius Venture Partners III (Ohio), L.P. Common Stock 969144 I By Radius Venture Partners III QP, L.P. Common Stock 88875 I By Radius Venture Partners III, L.P. Common Stock 3091 D 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, a director of the Issuer, and Mr. Davis share voting and dispositive power with respect to the shares held by Radius Venture Partners III (Ohio), L.P. 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, a director of the Issuer, and Mr. Davis share voting and dispositive power with respect to the shares held by Radius Venture Partners III QP, L.P. 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, a director of the Issuer, and Mr. Davis share voting and dispositive power with respect to the shares held by Radius Venture Partners III, L.P. 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. Pursuant to the terms of the award pertaining to shares of restricted common stock issued to the reporting person on September 28, 2016 pursuant to the issuer's 2016 Omnibus Incentive Compensation Plan, 2,474 of the shares were forfeited in connection with the reporting person's resignation as a director. The reporting person resigned from his position as a director of the issuer effective January 22, 2018. As a result, this Form 4 serves as his exit filing. /s/ Daniel C. Lubin 2018-02-22