SEC Form 4 · accession 0001104659-16-148725
Tabula Rasa HealthCare, Inc. · TRHC
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owners
Jordan Davis
10% Owner
RADIUS VENTURE PARTNERS III L P
10% Owner
Radius Venture Partners III QP, L.P.
10% Owner
Radius Venture Partners III, LLC
10% Owner
Period of report
Oct 4, 2016
Accepted (ET)
Oct 4, 2016 · 9:02 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 StockF4,F1 | Oct 4, 2016 | C | 154,792 | — | A | 191,603 | I | By Radius Venture Partners III (Ohio), L.P. |
| Common StockF4,F2 | Oct 4, 2016 | C | 1,232,499 | — | A | 1,525,599 | I | By Radius Venture Partners III QP, L.P. |
| Common StockF4,F3 | Oct 4, 2016 | C | 113,027 | — | A | 139,906 | I | By Radius Venture Partners III, L.P. |
| Common StockF1 | Oct 4, 2016 | J | 2,102 | $0.00 | D | 189,501 | I | By Radius Venture Partners III (Ohio), L.P. |
| Common StockF2 | Oct 4, 2016 | J | 16,735 | $0.00 | D | 1,508,864 | I | By Radius Venture Partners III QP, L.P. |
| Common StockF3 | Oct 4, 2016 | J | 1,535 | $0.00 | D | 138,371 | I | By Radius Venture Partners III, L.P. |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series A-1 Preferred StockF4,F5 | — | Oct 4, 2016 | C | 29,346 | D | — | — | Common Stock | 15,127 | 0 | I |
| Series A-1 Preferred StockF4,F5 | — | Oct 4, 2016 | C | 233,659 | D | — | — | Common Stock | 120,443 | 0 | I |
| Series A-1 Preferred StockF4,F5 | — | Oct 4, 2016 | C | 21,428 | D | — | — | Common Stock | 11,045 | 0 | I |
| Series B Preferred StockF4,F5 | — | Oct 4, 2016 | C | 270,952 | D | — | — | Common Stock | 139,665 | 0 | I |
| Series B Preferred StockF4,F5 | — | Oct 4, 2016 | C | 2,157,390 | D | — | — | Common Stock | 1,112,056 | 0 | I |
| Series B Preferred StockF4,F5 | — | Oct 4, 2016 | C | 197,846 | D | — | — | Common Stock | 101,982 | 0 | I |
Explanation of responses
- F1These securities are held directly by Radius Venture Partners III (Ohio), L.P. and indirectly by Radius Venture Partners III, LLC, the general partner of Radius Venture Partners III (Ohio), L.P., Jordan S. Davis, managing member of Radius Venture Partners III, LLC, and Daniel C. Lubin, managing member of Radius Venture Partners III, LLC. Mr. Lubin and Mr. Davis share voting and dispositive power with respect to the shares held by Radius Venture Partners III (Ohio), L.P. Mr. Lubin is a director of the Issuer and files separate Section 16 reports. Each of Radius Venture Partners III, LLC, Mr. Davis, and Mr. Lubin may be deemed to beneficially own such securities, and disclaims such beneficial ownership except to the extent of its or his pecuniary interest therein.
- F2These securities are held directly by Radius Venture Partners III QP, L.P and indirectly by Radius Venture Partners III, LLC, the general partner of Radius Venture Partners III QP, L.P., Jordan S. Davis, managing member of Radius Venture Partners III, LLC, and Daniel C. Lubin, managing member of Radius Venture Partners III, LLC. Mr. Lubin and Mr. Davis share voting and dispositive power with respect to the shares held by Radius Venture Partners III QP, L.P. Mr. Lubin is a director of the Issuer and files separate Section 16 reports. Each of Radius Venture Partners III, LLC, Mr. Davis, and Mr. Lubin may be deemed to beneficially own such securities, and disclaims such beneficial ownership except to the extent of its or his pecuniary interest therein.
- F3These securities are held directly by Radius Venture Partners III, L.P., and indirectly by Radius Venture Partners III, LLC, the general partner of Radius Venture Partners III, L.P., Jordan S. Davis, managing member of Radius Venture Partners III, LLC, and Daniel C. Lubin, managing member of Radius Venture Partners III, LLC. Mr. Lubin and Mr. Davis share voting and dispositive power with respect to the shares held by Radius Venture Partners III, L.P. Mr. Lubin is a director of the Issuer and files separate Section 16 reports. Each of Radius Venture Partners III, LLC, Mr. Davis, and Mr. Lubin may be deemed to beneficially own such securities, and disclaims such beneficial ownership except to the extent of its or his pecuniary interest therein.
- F4Each share of Series A-1 Preferred Stock and Series B Preferred Stock was converted automatically into shares of the Issuer's Common Stock immediately prior to the closing of Issuer's initial public offering.
- F5The securities did not have an expiration date.
- F620,372 shares of common stock were surrendered to the Issuer at the completion of Issuer's initial public offering pursuant to the letter agreement, dated as of June 30, 2014, as amended, with the Issuer.