SEC Form 3
FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 08/10/2020 | 3. Issuer Name and Ticker or Trading Symbol Tabula Rasa HealthCare, Inc. [ TRHC ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) 09/28/2016 | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Employee Stock Option (right to buy) | (1) | 06/28/2023(2) | Common Stock | 293,784 | 3.42(3) | D | |
Employee Stock Option (right to buy) | (1) | 06/28/2023(2) | Common Stock | 293,784 | 3.42(3) | I | Held by spouse. |
Employee Stock Option (right to buy) | (4) | 01/01/2025(11) | Common Stock | 21,432(5) | 5.82(6) | D | |
Employee Stock Option (right to buy) | (4) | 01/01/2025(11) | Common Stock | 21,432(7) | 5.82(6) | I | Held by spouse. |
Employee Stock Option (right to buy) | (4) | 01/01/2025 | Common Stock | 14,650(8) | 5.82 | D | |
Employee Stock Option (right to buy) | (4) | 01/01/2025 | Common Stock | 14,650(9) | 5.82 | I | Held by spouse. |
Employee Stock Option (right to buy) | 02/01/2015 | 02/01/2025(10) | Common Stock | 1,860 | 5.82(6) | D | |
Employee Stock Option (right to buy) | 02/01/2015 | 02/01/2025(10) | Common Stock | 1,662 | 5.82(6) | I | Held by spouse. |
Explanation of Responses: |
1. The Stock Option vests 25% on June 28, 2014 and in equal 1/36th installments each month thereafter. |
2. Prior disclosure stated the Expiration Date of this Stock Option was June 28, 2018. Notwithstanding the foregoing, the Expiration Date of this Stock Option is June 28, 2023. |
3. Prior disclosure stated the Exercise Price of this Stock Option was $3.41. Notwithstanding the foregoing, the Exercise Price of this Stock Option is $3.42. |
4. The Stock Option vests 25% on January 1, 2015 and in equal 1/36th installments each month thereafter. |
5. Prior disclosure stated the number of shares of Common Stock subject to this Stock Option was 36,082. Notwithstanding the foregoing, the number of shares of Common Stock subject to this Stock Option was 21,432. The Company made a separate grant of a Stock Option for 14,650 shares of Common Stock that was omitted from the reporting person's original Form 3. |
6. Prior disclosure stated the Exercise Price of this Stock Option was $6.40. Notwithstanding the foregoing, the Exercise Price of this Stock Option is $5.82. |
7. Prior disclosure stated the number of shares of Common Stock subject to this Stock Option was 36,082. Notwithstanding the foregoing, the number of shares of Common Stock subject to this Stock Option was 21,432. The Company made a separate grant of a Stock Option for 14,650 shares of Common Stock that was omitted from the Dr. Orsula V. Knowlton's original Form 3. |
8. This Stock Option was omitted from the reporting person's original Form 3. |
9. This Stock Option was omitted from the Dr. Orsula V. Knowlton's original Form 3. |
10. Prior disclosure stated the Expiration Date of this Stock Option was February 1, 2020. Notwithstanding the foregoing, the Expiration Date of this Stock Option is February 1, 2025. |
11. Prior disclosure stated the Expiration Date of this Stock Option was January 1, 2020. Notwithstanding the foregoing, the Expiration Date of this Stock Option is January 1, 2025. |
/s/ Brian W. Adams, by Power of Attorney | 08/12/2020 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |