Sec Form 4 Filing - ORIGINATE GROWTH FUND 1A LP @ Tabula Rasa HealthCare, Inc. - 2016-10-04

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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
ORIGINATE GROWTH FUND 1A LP
2. Issuer Name and Ticker or Trading Symbol
Tabula Rasa HealthCare, Inc. [ TRHC]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
205 WEBSTER STREET
3. Date of Earliest Transaction (MM/DD/YY)
10/04/2016
(Street)
BETHLEHEM, PA18015
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
_____ Form filed by One Reporting Person
__ X __ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 10/04/2016 C 472,560 A 510,218 D ( 2 )
Common Stock 10/04/2016 C 302,659 A 812,877 D ( 2 )
Common Stock 10/04/2016 C 53,912 A 866,789 D ( 2 )
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Series A Preferred Stock ( 1 ) 10/04/2016 C 916,766 ( 3 ) ( 3 ) Common Stock 472,560 ( 1 ) $ 0 ( 1 ) 0 D ( 2 )
Series A-1 Preferred Stock ( 1 ) 10/04/2016 C 587,158 ( 3 ) ( 3 ) Common Stock 302,659 ( 1 ) $ 0 ( 1 ) 0 D ( 2 )
Series B Preferred Stock ( 1 ) 10/04/2016 C 104,589 ( 3 ) ( 3 ) Common Stock 53,912 ( 1 ) $ 0 ( 1 ) 0 D ( 2 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
ORIGINATE GROWTH FUND 1A LP
205 WEBSTER STREET
BETHLEHEM, PA18015
X
Originate Growth GP, LLC
205 WEBSTER STREET
BETHLEHEM, PA18015
X
BRESSNER GLEN R
205 WEBSTER STREET
BETHLEHEM, PA18015
X X
Arnson Eric R
205 WEBSTER STREET
BETHLEHEM, PA18015
X
GAUSLING MICHAEL J
205 WEBSTER STREET
BETHLEHEM, PA18015
X
Signatures
Originate Growth Fund #1A, L.P.; By: Originate Growth GP, LLC; By: /s/ Glen Bressner, Managing Partner 10/04/2016
Signature of Reporting Person Date
Originate Growth GP, LLC; By: /s/ Glen Bressner, Managing Partner 10/04/2016
Signature of Reporting Person Date
/s/ Glen Bressner 10/04/2016
Signature of Reporting Person Date
/s/ Eric Arnson 10/04/2016
Signature of Reporting Person Date
/s/ Michael Gausling 10/04/2016
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Originate Growth Fund #1A, L.P. ("Originate #1A"), Originate #1A was the record holder of 916,766 shares of Series A Preferred Stock, which automatically converted into 472,560 shares of common stock upon the closing of the Issuer's initial public offering. Originate #1A was the record holder of 587,158 shares of Series A-1 Preferred Stock, which automatically converted into 302,659 shares of common stock upon the closing of the Issuer's initial public offering. Originate #1A was the record holder of 104,589 shares of Series B Preferred Stock, which automatically converted into 53,912 shares of common stock upon the closing of the Issuer's initial public offering.
( 2 )This report is filed jointly by Originate #1A, Originate Growth GP, LLC ("Originate GP"), Glen Bressner ("Bressner"), Eric Arnson ("Arnson"), and Michael Gausling ("Gausling"). 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.
( 3 )All series of Preferred Stock automatically converted into Tabula Rasa HealthCare, Inc. (the "Issuer") common stock immediately prior to the closing of the initial public offering and have no expiration date.

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