SEC Form 4 · accession 0001104659-16-148643
Tabula Rasa HealthCare, Inc. · TRHC
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owners
Period of report
Oct 4, 2016
Accepted (ET)
Oct 4, 2016 · 5:04 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 StockF1,F4,F2 | Oct 4, 2016 | C | 758,036 | $0.00 | A | 783,809 | D | |
| Common StockF1,F4,F3 | Oct 4, 2016 | C | 171,033 | $0.00 | A | 954,842 | D |
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 StockF1,F4,F2 | $0.00 | Oct 4, 2016 | C | 1,470,590 | A | — | — | Common Stock | 758,036 | 0 | D |
| Series A-1 Preferred StockF1,F4,F3 | $0.00 | Oct 4, 2016 | C | 331,804 | A | — | — | Common Stock | 171,033 | 0 | D |
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 Issuer's initial public offering, 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 Issuer's initial public offering, 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 Persons disclaim beneficial ownership (as defined in Rule 16a-1(a)(2)) of the securities reported herein (except to the extent of their pecuniary interest in such securities), and this report shall not be deemed an admission that any Reporting Person is the beneficial owner of the securities for purposes of Section 16 or for any other purpose.