FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
Tabula Rasa HealthCare, Inc. [ TRHC ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 03/20/2018 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 03/20/2018 | J(1) | 816,910 | D | $0 | 5,617 | I(2)(3) | By: Originate Growth Fund 1Q, L.P. | ||
Common Stock | 03/20/2018 | J(1) | 369,929 | D | $0 | 2,544 | I(2)(4) | By: Originate Growth Fund 1A, L.P. | ||
Common Stock | 7,800 | I(2) | By: Originate Growth GP, LLC | |||||||
Common Stock | 104,387(5) | I | As trustee of family trust | |||||||
Common Stock | 20,381(5) | D |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
1. Pro rata, in-kind distribution to partners without consideration. |
2. The general partner of Originate Growth Fund #1Q, L.P. and Originate Growth Fund #1A, L.P. is Originate Growth GP, LLC. The members of Originate Growth GP, LLC are Glen R. Bressner, Eric R. Arnson and Michael J. Gausling. The members of Originate Growth GP, LLC share voting and dispositive power over the shares held by Originate Growth GP, LLC, Originate Growth Fund #1Q, L.P. and Originate Growth Fund #1A, L.P. Mr. Bressner disclaims beneficial ownership of such shares, except to the extent of his pecuniary interest. |
3. Includes 5,616 shares originally granted to the Reporting Person by the Issuer as director compensation, which was held for the benefit of Originate Growth Fund #1Q, L.P. |
4. Includes 2,545 shares originally granted to the Reporting Person by the Issuer as director compensation, which was held for the benefit of Originate Growth Fund #1A, L.P. |
5. Includes shares received in a pro rata, in-kind distribution to partners by Originate Growth Fund #1Q, L.P. and Originate Growth Fund #1A, L.P. Such shares had previously been reported as being held indirectly by the Reporting Person through the foregoing partnerships. |
Remarks: |
Glen Bressner | 03/22/2018 | |
** 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 4 (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. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |