SEC FORM 3

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^*

ORIGINATE GROWTH FUND 1A LP

(Last)

(First)

(Middle)

205 WEBSTER STREET

(Street)

BETHLEHEM

18015

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
09/28/2016

3. Issuer Name and Ticker or Trading Symbol
Tabula Rasa HealthCare, Inc. [ TRHC ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

Director	X	10% Owner
Officer (give title below)		Other (specify below)

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

	Form filed by One Reporting Person
X	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)
Common Stock	37,658	D

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)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	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)
Series A Preferred Stock	⁽¹⁾	⁽¹⁾	Common Stock	472,560	⁽²⁾	D⁽³⁾
Series A-1 Preferred Stock	⁽¹⁾	⁽¹⁾	Common Stock	302,659	⁽²⁾	D⁽³⁾
Series B Preferred Stock	⁽¹⁾	⁽¹⁾	Common Stock	53,912	⁽²⁾	D⁽³⁾

1. Name and Address of Reporting Person^*

ORIGINATE GROWTH FUND 1A LP

(Last)

(First)

(Middle)

205 WEBSTER STREET

(Street)

BETHLEHEM

18015

(City)

(State)

(Zip)

Relationship of Reporting Person(s) to Issuer

Director	X	10% Owner
Officer (give title below)		Other (specify below)

1. Name and Address of Reporting Person^*

BRESSNER GLEN R

(Last)

(First)

(Middle)

205 WEBSTER STREET

(Street)

BETHLEHEM

18015

(City)

(State)

(Zip)

Relationship of Reporting Person(s) to Issuer

X	Director	X	10% Owner
	Officer (give title below)		Other (specify below)

Explanation of Responses:

1. All series of Preferred Stock will automatically convert into Tabula Rasa HealthCare, Inc. (the "Issuer") common stock immediately prior to the closing of the initial public offering and have no expiration date.

2. This report is filed jointly by Originate Growth Fund #1A, L.P. ("Originate #1A"), Originate Growth GP, LLC ("Originate GP"), Glen Bressner ("Bressner"), Eric Arnson ("Arnson"), and Michael Gausling ("Gausling"). Originate #1A is the record holder of 916,766 shares of Series A Preferred Stock, which will automatically convert into 472,560 shares of common stock upon the closing of the Issuer's initial public offering. Originate #1A is the record holder of 587,158 shares of Series A-1 Preferred Stock, which will automatically convert into 302,659 shares of common stock upon the closing of the Issuer's initial public offering. Originate #1A is the record holder of 104,589 shares of Series B Preferred Stock, which will automatically convert into 53,912 shares of common stock upon the closing of the Issuer's initial public offering.

3. 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.

Remarks:

	Originate Growth Fund #1A, L.P. By: Originate Growth GP, LLC By: /s/ Glen Bressner, Managing Partner	09/28/2016
	Originate Growth GP, LLC By: /s/ Glen Bressner, Managing Partner	09/28/2016
	/s/ Glen Bressner	09/28/2016
	/s/ Eric Arnson	09/28/2016
	/s/ Michael J. Gausling	09/28/2016
	** 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).
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