SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
Knowlton Orsula V

(Last) (First) (Middle)
228 STRAWBRIDGE DRIVE
SUITE 100

(Street)
MOORESTOWN NJ 08057

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
08/10/2020
3. Issuer Name and Ticker or Trading Symbol
Tabula Rasa HealthCare, Inc. [ TRHC ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
President
5. If Amendment, Date of Original Filed (Month/Day/Year)
09/28/2016
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Employee Stock Option (right to buy) (1) 06/28/2023(2) Common Stock 293,784 $3.42(3) D
Employee Stock Option (right to buy) (1) 06/28/2023(2) Common Stock 293,784 $3.42(3) I Held by spouse.
Employee Stock Option (right to buy) (4) 01/01/2025(11) Common Stock 21,432(5) $5.82(6) D
Employee Stock Option (right to buy) (4) 01/01/2025(11) Common Stock 21,432(7) $5.82(6) I Held by spouse.
Employee Stock Option (right to buy) (4) 01/01/2025 Common Stock 14,650(8) $5.82 D
Employee Stock Option (right to buy) (4) 01/01/2025 Common Stock 14,650(9) $5.82 I Held by spouse.
Employee Stock Option (right to buy) 02/01/2015 02/01/2025(10) Common Stock 1,662 $5.82(6) D
Employee Stock Option (right to buy) 02/01/2015 02/01/2025(10) Common Stock 1,860 $5.82(6) I Held by spouse.
Explanation of Responses:
1. The Stock Option vests 25% on June 28, 2014 and in equal 1/36th installments each month thereafter.
2. Prior disclosure stated the Expiration Date of this Stock Option was June 28, 2018. Notwithstanding the foregoing, the Expiration Date of this Stock Option is June 28, 2023.
3. Prior disclosure stated the Exercise Price of this Stock Option was $3.41. Notwithstanding the foregoing, the Exercise Price of this Stock Option is $3.42.
4. The Stock Option vests 25% on January 1, 2015 and in equal 1/36th installments each month thereafter.
5. Prior disclosure stated the number of shares of Common Stock subject to this Stock Option was 36,082. Notwithstanding the foregoing, the number of shares of Common Stock subject to this Stock Option was 21,432. The Company made a separate grant of a Stock Option for 14,650 shares of Common Stock that was omitted from the reporting person's original Form 3.
6. Prior disclosure stated the Exercise Price of this Stock Option was $6.40. Notwithstanding the foregoing, the Exercise Price of this Stock Option is $5.82.
7. Prior disclosure stated the number of shares of Common Stock subject to this Stock Option was 36,082. Notwithstanding the foregoing, the number of shares of Common Stock subject to this Stock Option was 21,432. The Company made a separate grant of a Stock Option for 14,650 shares of Common Stock that was omitted from the Dr. Calvin H. Knowlton's original Form 3.
8. This Stock Option was omitted from the reporting person's original Form 3.
9. This Stock Option was omitted from the Dr. Calvin H. Knowlton's original Form 3.
10. Prior disclosure stated the Expiration Date of this Stock Option was February 1, 2020. Notwithstanding the foregoing, the Expiration Date of this Stock Option is February 1, 2025.
11. Prior disclosure stated the Expiration Date of this Stock Option was January 1, 2020. Notwithstanding the foregoing, the Expiration Date of this Stock Option is January 1, 2025.
/s/ Brian W. Adams, by Power of Attorney 08/12/2020
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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