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