0001104659-16-148642.txt : 20161004 0001104659-16-148642.hdr.sgml : 20161004 20161004170320 ACCESSION NUMBER: 0001104659-16-148642 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: Luehrs Bruce CENTRAL INDEX KEY: 0001352929 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37888 FILM NUMBER: 161919870 MAIL ADDRESS: STREET 1: 8270 GREENSBORO DRIVE STREET 2: SUITE 850 CITY: MCLEAN STATE: VA ZIP: 22102 4 1 a4.xml 4 X0306 4 2016-10-04 0 0001651561 Tabula Rasa HealthCare, Inc. TRHC 0001352929 Luehrs Bruce 4801 S. BROAD ST., SUITE 400 PHILADELPHIA PA 19112 1 0 0 0 Common Stock 2016-10-04 4 C 0 758036 0 A 789374 I See footnotes Common Stock 2016-10-04 4 C 0 171033 0 A 960407 I See footnotes Series A Preferred Stock 0 2016-10-04 4 C 0 1470590 0 D Common Stock 758036 0 I See footnotes Series A-1 Preferred Stock 0 2016-10-04 4 C 0 331804 0 D Common Stock 171033 0 I See footnotes These securities are held by Emerald Stage2Ventures, L.P. Stage2 Capital Ventures Associates, L.P. is the general partner of Emerald Stage2 Ventures, L.P. and Stage2 Capital Associates G.P., LLC is the general partner of Stage2 Capital Ventures Associates, L.P. Bruce Luehrs, who serves as a director of the Issuer, is an officer of Stage2 Capital Associates G.P., LLC. The Series A Preferred Stock converted into Common Stock on a 1:1.94 basis and had no expiration date. Immediately prior to the completion of the initial public offering of the Issuer, all shares of Series A Preferred Stock were converted into shares of Common Stock of the Issuer. Upon such conversion, 1,470,590 shares of Series A Preferred Stock held by Emerald Stage2Ventures, L.P. converted into 758,036 shares of Common Stock. The Series A-1 Preferred Stock converted into Common Stock on a 1:1.94 basis and had no expiration date. Immediately prior to the completion of the initial public offering of the Issuer, all shares of Series A-1 Preferred Stock were converted into shares of Common Stock of the Issuer. Upon such conversion, 331,804 shares of Series A-1 Preferred Stock held by Emerald Stage2Ventures, L.P. converted into 171,033 shares of Common Stock. The Reporting Person disclaims beneficial ownership (as defined in Rule 16a-1(a)(2)) of the securities reported herein (except to the extent of his pecuniary interest in such securities), and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of the securities for purposes of Section 16 or for any other purpose. /s/ Brian W. Adams, as attorney-in-fact for Reporting Person 2016-10-04