0001384604-16-000002.txt : 20160928
0001384604-16-000002.hdr.sgml : 20160928
20160928184705
ACCESSION NUMBER: 0001384604-16-000002
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20160928
FILED AS OF DATE: 20160928
DATE AS OF CHANGE: 20160928
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: BRESSNER GLEN R
CENTRAL INDEX KEY: 0000902959
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37888
FILM NUMBER: 161908019
MAIL ADDRESS:
STREET 1: 720 PENNSYLAVANIA DR
CITY: EXTON
STATE: PA
ZIP: 19341
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: ORIGINATE GROWTH FUND 1A LP
CENTRAL INDEX KEY: 0001384604
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37888
FILM NUMBER: 161908020
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
3
1
edgar.xml
PRIMARY DOCUMENT
X0206
3
2016-09-28
0
0001651561
Tabula Rasa HealthCare, Inc.
TRHC
0001384604
ORIGINATE GROWTH FUND 1A LP
205 WEBSTER STREET
BETHLEHEM
PA
18015
0
0
1
0
0000902959
BRESSNER GLEN R
205 WEBSTER STREET
BETHLEHEM
PA
18015
1
0
1
0
Common Stock
37658
D
Series A Preferred Stock
Common Stock
472560
D
Series A-1 Preferred Stock
Common Stock
302659
D
Series B Preferred Stock
Common Stock
53912
D
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.
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.
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.
Originate Growth Fund #1A, L.P. By: Originate Growth GP, LLC By: /s/ Glen Bressner, Managing Partner
2016-09-28
Originate Growth GP, LLC By: /s/ Glen Bressner, Managing Partner
2016-09-28
/s/ Glen Bressner
2016-09-28
/s/ Eric Arnson
2016-09-28
/s/ Michael J. Gausling
2016-09-28