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