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)
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2. Date of Event Requiring Statement
(Month/Day/Year) 10/12/2006 |
3. Issuer Name and Ticker or Trading Symbol
eHealth, Inc. [ EHTH ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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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) |
Common Stock | 9,806 | D(1) | |
Common Stock | 11,215 | D(2) | |
Common Stock | 1,413 | D(3) | |
Common Stock | 434 | D(4) | |
Common Stock | 18,296 | D(5) | |
Common Stock | 153 | D(6) | |
Common Stock | 3,755 | D(7) | |
Common Stock | 411 | D(8) | |
Common Stock | 254 | D(9) |
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 | ||||
Series A Convertible Preferred Stock | (10) | (10) | Common Stock | 232,298 | (10) | D(1) | |
Series A Convertible Preferred Stock | (10) | (10) | Common Stock | 265,669 | (10) | D(2) | |
Series A Convertible Preferred Stock | (10) | (10) | Common Stock | 33,479 | (10) | D(3) | |
Series A Convertible Preferred Stock | (10) | (10) | Common Stock | 10,293 | (10) | D(4) | |
Series A Convertible Preferred Stock | (10) | (10) | Common Stock | 433,391 | (10) | D(5) | |
Series A Convertible Preferred Stock | (10) | (10) | Common Stock | 3,629 | (10) | D(6) | |
Series A Convertible Preferred Stock | (10) | (10) | Common Stock | 88,953 | (10) | D(7) | |
Series A Convertible Preferred Stock | (10) | (10) | Common Stock | 9,751 | (10) | D(8) | |
Series A Convertible Preferred Stock | (10) | (10) | Common Stock | 6,013 | (10) | D(9) | |
Series B Convertible Preferred Stock | (11) | (11) | Common Stock | 60,817 | (11) | D(1) | |
Series B Convertible Preferred Stock | (11) | (11) | Common Stock | 69,554 | (11) | D(2) | |
Series B Convertible Preferred Stock | (11) | (11) | Common Stock | 8,765 | (11) | D(3) | |
Series B Convertible Preferred Stock | (11) | (11) | Common Stock | 2,695 | (11) | D(4) | |
Series B Convertible Preferred Stock | (11) | (11) | Common Stock | 113,466 | (11) | D(5) | |
Series B Convertible Preferred Stock | (11) | (11) | Common Stock | 950 | (11) | D(6) | |
Series B Convertible Preferred Stock | (11) | (11) | Common Stock | 23,289 | (11) | D(7) | |
Series B Convertible Preferred Stock | (11) | (11) | Common Stock | 2,553 | (11) | D(8) | |
Series B Convertible Preferred Stock | (11) | (11) | Common Stock | 1,573 | (11) | D(9) | |
Series C Convertible Preferred Stock | (12) | (12) | Common Stock | 56,086 | (12) | D(1) | |
Series C Convertible Preferred Stock | (12) | (12) | Common Stock | 64,130 | (12) | D(2) | |
Series C Convertible Preferred Stock | (12) | (12) | Common Stock | 8,096 | (12) | D(3) | |
Series C Convertible Preferred Stock | (12) | (12) | Common Stock | 2,485 | (12) | D(4) | |
Series C Convertible Preferred Stock | (12) | (12) | Common Stock | 104,639 | (12) | D(5) | |
Series C Convertible Preferred Stock | (12) | (12) | Common Stock | 876 | (12) | D(6) | |
Series C Convertible Preferred Stock | (12) | (12) | Common Stock | 21,476 | (12) | D(7) | |
Series C Convertible Preferred Stock | (12) | (12) | Common Stock | 2,354 | (12) | D(8) | |
Series C Convertible Preferred Stock | (12) | (12) | Common Stock | 1,452 | (12) | D(9) |
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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Explanation of Responses: |
1. Shares are held by WPG Enterprise Fund III, LLC ("WPGEF III"). Mr. Schaepe is a managing member of WPG VC Fund Adviser, LLC, which is the fund investment advisory member of WPGEF III. Mr. Schaepe disclaims beneficial ownership of any of the shares held by WPGEF III, except to the extent of his pecuniary interest therein. |
2. Shares are held by Weiss, Peck & Greer Venture Associates IV, LLC ("WPGVA IV"). Mr. Schaepe is a managing member of WPG VC Fund Adviser, LLC, which is the fund investment advisory member of WPGVA IV. Mr. Schaepe disclaims beneficial ownership of any of the shares held by WPGVA IV, except to the extent of his pecuniary interest therein. |
3. Shares are held by Weiss, Peck & Greer Venture Associates IV Cayman, LP ("WPGVA IV Cayman"). Mr. Schaepe is a managing member of WPG VC Fund Adviser, LLC, which is the fund investment advisory partner of WPGVA IV Cayman. Mr. Schaepe disclaims beneficial ownership of any of the shares held by WPGVA IV Cayman, except to the extent of his pecuniary interest therein. |
4. Shares are held by WPG Information Sciences Entrepreneur Fund, LP ("WPGISEF"). Mr. Schaepe is a managing member of WPG VC Fund Adviser, LLC, which is the general partner of WPGISEF. Mr. Schaepe disclaims beneficial ownership of any of the shares held by WPGISEF, except to the extent of his pecuniary interest therein. |
5. Shares are held by Weiss, Peck & Greer Venture Associates V, LLC ("WPGVA V"). Mr. Schaepe is a managing member of WPG VC Fund Adviser II, LLC, which is the fund investment advisory member of WPGVA V. Mr. Schaepe disclaims beneficial ownership of any of the shares held by WPGVA V, except to the extent of his pecuniary interest therein. |
6. Shares are held by Weiss, Peck & Greer Venture Associates V-A, LLC ("WPGVA V-A"). Mr. Schaepe is a managing member of WPG VC Fund Adviser II, LLC, which is the fund investment advisory member of WPGVA V-A. Mr. Schaepe disclaims beneficial ownership of any of the shares held by WPGVA V-A, except to the extent of his pecuniary interest therein. |
7. Shares are held by Weiss, Peck & Greer Venture Associates V Cayman, LP ("WPGVA V Cayman"). Mr. Schaepe is a managing member of WPG VC Fund Adviser II, LLC, which is the fund investment advisory partner of WPGVA V Cayman. Mr. Schaepe disclaims beneficial ownership of any of the shares held by WPGVA V Cayman, except to the extent of his pecuniary interest therein. |
8. Shares are held by WPG Information Sciences Entrepreneur Fund II, LLC ("WPGISEF II"). Mr. Schaepe is a managing member of WPG VC Fund Adviser II, LLC, which is the fund investment advisory member of WPGISEF II. Mr. Schaepe disclaims beneficial ownership of any of the shares held by WPGISEF II, except to the extent of his pecuniary interest therein. |
9. Shares are held by WPG Information Sciences Entrepreneur Fund II-A, LLC ("WPGISEF II-A"). Mr. Schaepe is a managing member of WPG VC Fund Adviser II, LLC, which is the fund investment advisory member of WPGISEF II-A. Mr. Schaepe disclaims beneficial ownership of any of the shares held by WPGISEF II-A, except to the extent of his pecuniary interest therein. |
10. The Series A Convertible Preferred Stock is convertible into Issuer's common stock on a 1-for-1 basis immediately upon the consummation of the Issuer's initial public offering and has no expiration date. |
11. The Series B Convertible Preferred Stock is convertible into Issuer's common stock on a 1-for-1.3145 basis immediately upon the consummation of the Issuer's initial public offering and has no expiration date. The number of shares in Column 3 reflects the conversion ratio to be effective upon the closing of the Issuer's initial public offering. |
12. The Series C Convertible Preferred Stock is convertible into Issuer's common stock on a 1-for-1 basis immediately upon the consummation of the Issuer's initial public offering and has no expiration date. |
Remarks: |
This Form 3 is being filed twice because there are more than 10 joint filers. See Exhibit 99 - Joint Filer Information |
Christopher J. Schaepe | 10/12/2006 | |
Christopher J. Schaepe, Managing Member, WPG VC Fund Adviser, LLC, for WPGEF III, WPGVA IV, WPGVA IV Cayman, WPGISEF | 10/12/2006 | |
Christopher J. Schaepe, Managing Member, WPG VC Fund Adviser II, LLC, for WPGVA V, WPGVA V-A, WPGVA V Cayman, WPGISEF II, WPGISEF II-A | 10/12/2006 | |
** 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. |