0001192482-16-000723.txt : 20161005
0001192482-16-000723.hdr.sgml : 20161005
20161005162615
ACCESSION NUMBER: 0001192482-16-000723
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20161004
FILED AS OF DATE: 20161005
DATE AS OF CHANGE: 20161005
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: GAUSLING MICHAEL J
CENTRAL INDEX KEY: 0001125761
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37888
FILM NUMBER: 161922729
MAIL ADDRESS:
STREET 1: 150 WEBSTER STREET
CITY: BETHLEHEM
STATE: PA
ZIP: 18015
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Arnson Eric R
CENTRAL INDEX KEY: 0001685942
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37888
FILM NUMBER: 161922730
MAIL ADDRESS:
STREET 1: 205 WEBSTER STREET
CITY: BETHLEHEM
STATE: PA
ZIP: 18015
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: BRESSNER GLEN R
CENTRAL INDEX KEY: 0000902959
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37888
FILM NUMBER: 161922731
MAIL ADDRESS:
STREET 1: 720 PENNSYLAVANIA DR
CITY: EXTON
STATE: PA
ZIP: 19341
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Originate Growth GP, LLC
CENTRAL INDEX KEY: 0001685914
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37888
FILM NUMBER: 161922732
BUSINESS ADDRESS:
STREET 1: 205 WEBSTER STREET
CITY: BETHLEHEM
STATE: PA
ZIP: 18015
BUSINESS PHONE: (610) 866-5588
MAIL ADDRESS:
STREET 1: 205 WEBSTER STREET
CITY: BETHLEHEM
STATE: PA
ZIP: 18015
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: ORIGINATE GROWTH FUND 1A LP
CENTRAL INDEX KEY: 0001384604
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37888
FILM NUMBER: 161922733
BUSINESS ADDRESS:
STREET 1: C/O ORIGINATE GROWTH FUND GP LLC
STREET 2: 205 WEBSTER STREET
CITY: BETHLEHEM
STATE: PA
ZIP: 18015
BUSINESS PHONE: 6108665588
MAIL ADDRESS:
STREET 1: C/O ORIGINATE GROWTH FUND GP LLC
STREET 2: 205 WEBSTER STREET
CITY: BETHLEHEM
STATE: PA
ZIP: 18015
4
1
edgar.xml
PRIMARY DOCUMENT
X0306
4
2016-10-04
0001651561
Tabula Rasa HealthCare, Inc.
TRHC
0001384604
ORIGINATE GROWTH FUND 1A LP
205 WEBSTER STREET
BETHLEHEM
PA
18015
0
0
1
0
0001685914
Originate Growth GP, LLC
205 WEBSTER STREET
BETHLEHEM
PA
18015
0
0
1
0
0000902959
BRESSNER GLEN R
205 WEBSTER STREET
BETHLEHEM
PA
18015
1
0
1
0
0001685942
Arnson Eric R
205 WEBSTER STREET
BETHLEHEM
PA
18015
0
0
1
0
0001125761
GAUSLING MICHAEL J
205 WEBSTER STREET
BETHLEHEM
PA
18015
0
0
1
0
Common Stock
2016-10-04
4
C
0
472560
A
510218
D
Common Stock
2016-10-04
4
C
0
302659
A
812877
D
Common Stock
2016-10-04
4
C
0
53912
A
866789
D
Series A Preferred Stock
2016-10-04
4
C
0
916766
0
D
Common Stock
472560
0
D
Series A-1 Preferred Stock
2016-10-04
4
C
0
587158
0
D
Common Stock
302659
0
D
Series B Preferred Stock
2016-10-04
4
C
0
104589
0
D
Common Stock
53912
0
D
Originate Growth Fund #1A, L.P. ("Originate #1A"), Originate #1A was the record holder of 916,766 shares of Series A Preferred Stock, which automatically converted into 472,560 shares of common stock upon the closing of the Issuer's initial public offering. Originate #1A was the record holder of 587,158 shares of Series A-1 Preferred Stock, which automatically converted into 302,659 shares of common stock upon the closing of the Issuer's initial public offering. Originate #1A was the record holder of 104,589 shares of Series B Preferred Stock, which automatically converted into 53,912 shares of common stock upon the closing of the Issuer's initial public offering.
This report is filed jointly by Originate #1A, Originate Growth GP, LLC ("Originate GP"), Glen Bressner ("Bressner"), Eric Arnson ("Arnson"), and Michael Gausling ("Gausling"). The shares are held by Originate #1A. The general partner of Originate #1A is Originate GP, a limited liability company. The members of Originate GP are Bressner, Arnson, and Gausling. The members of Originate GP share voting and dispositive power over the shares held by Originate #1A. Each of these individuals disclaims beneficial ownership of such shares, except to the extent of his pecuniary interest.
All series of Preferred Stock automatically converted into Tabula Rasa HealthCare, Inc. (the "Issuer") common stock immediately prior to the closing of the initial public offering and have no expiration date.
Originate Growth Fund #1A, L.P.; By: Originate Growth GP, LLC; By: /s/ Glen Bressner, Managing Partner
2016-10-04
Originate Growth GP, LLC; By: /s/ Glen Bressner, Managing Partner
2016-10-04
/s/ Glen Bressner
2016-10-04
/s/ Eric Arnson
2016-10-04
/s/ Michael Gausling
2016-10-04