SEC Form 4
FORM 4 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
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
JACOBSON HARRY R

(Last) (First) (Middle)
25 CORPORATE DRIVE, SUITE 310

(Street)
BURLINGTON MA 01803

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
HEALTHGATE DATA CORP [ HGAT ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
11/03/2003
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 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 11/03/2003 P 1,100 A $0.5 1,100 I As custodian for child and/or grandchild(1)
Common Stock 11/06/2003 P 200 A $0.5 1,300 I As custodian for child and/or grandchild(1)
Common Stock 11/11/2003 P 183 A $0.5 1,483 I As custodian for child and/or grandchild(1)
Common Stock 12/01/2003 P 1,800 A $0.5 3,283 I As custodian for child and/or grandchild(1)
Common Stock 12/01/2003 P 717 A $0.45 4,000 I As custodian for child and/or grandchild(1)
Common Stock 115,700 I by EBM Solutions, Inc.(2)
Common Stock 55,556 D
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 (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 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 (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (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: 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
Stock Options $0.7 10/27/2003 10/27/2008 Common Stock 35,000(4) 35,000 D
Common Stock Warrant $1.2 10/27/2003 04/27/2005 Common Stock 51,282 51,282 I by EBM Solutions, Inc.(3)
Explanation of Responses:
1. The reporting person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the reporting person is the beneficial owner of the securities for purposes of Section 16 or for any other purpose.
2. Does not include the 4,000 shares held indirectly by the reporting person as custodian for his children and grandchildren. Represents shares of the issuer held by EBM Solutions, Inc. ("EBM") and such shares are expected to be distributed to the reporting person upon EBM's anticipated liquidation. The reporting person is a director and shareholder of EBM. The reporting person disclaims beneficial ownership of the other 636,348 shares of the issuer which are held by EBM and which will be distributed to its other shareholders upon its liquidation; this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose.
3. Represents shares of common stock issuable under a warrant of the issuer held by EBM and such warrants are expected to be distributed to the reporting person upon EBM's anticipated liquidation. The reporting person is a director and shareholder of EBM. The reporting person disclaims beneficial ownership of the other 282,051 shares of common stock issuable under a warrant of the issuer which is held by EBM and which will be distributed to its other shareholders upon its liquidation; this report shall not be deemed an admission that the reporting person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose.
4. Subject to vesting.
/s/ Harry R. Jacobson 12/02/2003
** 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 4 (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.