SEC Form 4 · accession 0001104659-16-148642

Tabula Rasa HealthCare, Inc. · TRHC

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Bruce Luehrs

Director

Period of report

Oct 4, 2016

Accepted (ET)

Oct 4, 2016 · 5:03 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001651561

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F2,F1,F4	Oct 4, 2016	C	758,036	$0.00	A	789,374	I	See footnotes
Common Stock^F3,F1,F4	Oct 4, 2016	C	171,033	$0.00	A	960,407	I	See footnotes

Table II — derivative securities

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Series A Preferred Stock^F1,F4,F2	$0.00	Oct 4, 2016	C	1,470,590	D	—	—	Common Stock	758,036	0	I
Series A-1 Preferred Stock^F1,F4,F3	$0.00	Oct 4, 2016	C	331,804	D	—	—	Common Stock	171,033	0	I

Explanation of responses

F1These securities are held by Emerald Stage2Ventures, L.P. Stage2 Capital Ventures Associates, L.P. is the general partner of Emerald Stage2 Ventures, L.P. and Stage2 Capital Associates G.P., LLC is the general partner of Stage2 Capital Ventures Associates, L.P. Bruce Luehrs, who serves as a director of the Issuer, is an officer of Stage2 Capital Associates G.P., LLC.
F2The Series A Preferred Stock converted into Common Stock on a 1:1.94 basis and had no expiration date. Immediately prior to the completion of the initial public offering of the Issuer, all shares of Series A Preferred Stock were converted into shares of Common Stock of the Issuer. Upon such conversion, 1,470,590 shares of Series A Preferred Stock held by Emerald Stage2Ventures, L.P. converted into 758,036 shares of Common Stock.
F3The Series A-1 Preferred Stock converted into Common Stock on a 1:1.94 basis and had no expiration date. Immediately prior to the completion of the initial public offering of the Issuer, all shares of Series A-1 Preferred Stock were converted into shares of Common Stock of the Issuer. Upon such conversion, 331,804 shares of Series A-1 Preferred Stock held by Emerald Stage2Ventures, L.P. converted into 171,033 shares of Common Stock.
F4The Reporting Person disclaims beneficial ownership (as defined in Rule 16a-1(a)(2)) of the securities reported herein (except to the extent of his pecuniary interest in such securities), and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of the securities for purposes of Section 16 or for any other purpose.