SEC FORM
3
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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OMB APPROVAL |
OMB Number: |
3235-0104 |
Estimated average burden |
hours per response: |
0.5 |
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1. Name and Address of Reporting Person*
C/O LIGHTSPEED VENTURE PARTNERS |
2200 SAND HILL ROAD |
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 10/12/2006
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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)
X |
Director |
X |
10% Owner |
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Officer (give title below) |
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Other (specify below) |
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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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Form filed by One Reporting Person |
X |
Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Beneficially Owned |
1. Title of Security (Instr.
4)
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2.
Amount of Securities Beneficially Owned (Instr.
4)
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3. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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4. Nature of Indirect Beneficial Ownership (Instr.
5)
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Common Stock |
9,806 |
D
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Common Stock |
11,215 |
D
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Common Stock |
1,413 |
D
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Common Stock |
434 |
D
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Common Stock |
18,296 |
D
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Common Stock |
153 |
D
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Common Stock |
3,755 |
D
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Common Stock |
411 |
D
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Common Stock |
254 |
D
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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)
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2. Date Exercisable and Expiration Date
(Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr.
4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form: Direct (D) or Indirect (I) (Instr.
5)
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6. Nature of Indirect Beneficial Ownership (Instr.
5)
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Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Series A Convertible Preferred Stock |
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Common Stock |
232,298 |
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D
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Series A Convertible Preferred Stock |
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Common Stock |
265,669 |
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D
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Series A Convertible Preferred Stock |
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Common Stock |
33,479 |
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D
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Series A Convertible Preferred Stock |
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Common Stock |
10,293 |
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D
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Series A Convertible Preferred Stock |
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Common Stock |
433,391 |
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D
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Series A Convertible Preferred Stock |
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Common Stock |
3,629 |
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D
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Series A Convertible Preferred Stock |
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Common Stock |
88,953 |
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D
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Series A Convertible Preferred Stock |
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Common Stock |
9,751 |
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D
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Series A Convertible Preferred Stock |
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Common Stock |
6,013 |
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D
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Series B Convertible Preferred Stock |
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Common Stock |
60,817 |
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D
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Series B Convertible Preferred Stock |
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Common Stock |
69,554 |
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D
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Series B Convertible Preferred Stock |
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Common Stock |
8,765 |
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D
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Series B Convertible Preferred Stock |
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Common Stock |
2,695 |
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D
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Series B Convertible Preferred Stock |
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Common Stock |
113,466 |
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D
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Series B Convertible Preferred Stock |
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Common Stock |
950 |
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D
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Series B Convertible Preferred Stock |
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Common Stock |
23,289 |
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D
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Series B Convertible Preferred Stock |
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Common Stock |
2,553 |
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D
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Series B Convertible Preferred Stock |
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Common Stock |
1,573 |
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D
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Series C Convertible Preferred Stock |
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Common Stock |
56,086 |
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D
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Series C Convertible Preferred Stock |
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Common Stock |
64,130 |
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D
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Series C Convertible Preferred Stock |
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Common Stock |
8,096 |
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D
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Series C Convertible Preferred Stock |
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Common Stock |
2,485 |
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D
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Series C Convertible Preferred Stock |
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Common Stock |
104,639 |
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D
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Series C Convertible Preferred Stock |
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Common Stock |
876 |
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D
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Series C Convertible Preferred Stock |
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Common Stock |
21,476 |
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D
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Series C Convertible Preferred Stock |
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Common Stock |
2,354 |
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D
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Series C Convertible Preferred Stock |
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Common Stock |
1,452 |
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D
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1. Name and Address of Reporting Person*
C/O LIGHTSPEED VENTURE PARTNERS |
2200 SAND HILL ROAD |
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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Explanation of Responses: |
Remarks: |
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Christopher J. Schaepe |
10/12/2006 |
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Christopher J. Schaepe, Managing Member, WPG VC Fund Adviser, LLC, for WPGEF III, WPGVA IV, WPGVA IV Cayman, WPGISEF |
10/12/2006 |
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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 |
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** 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. |
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Exhibit 99 Joint Filer Information
Name: WPG Enterprise Fund III, LLC Name: WPG Information Sciences Entrepreneur Fund II, LLC
Address: c/o Lightspeed Venture Partners,2200 Address: c/o Lightspeed Venture Partners,2200
Sand Hill Road, Menlo Park, CA 94025 Sand Hill Road, Menlo Park, CA 94025
Designated Filer: Schaepe, Christopher J. Designated Filer: Schaepe, Christopher J.
Issuer and Ticker Symbol: eHealth, Inc. (EHTH) Issuer and Ticker Symbol: eHealth, Inc. (EHTH)
Date of Event Requiring Statement: October 12, 2006 Date of Event Requiring Statement: October 12, 2006
Name: Weiss, Peck & Greer Venture Associates IV, LLC Name: WPG Information Sciences Entrepreneur Fund II-A,
Address: c/o Lightspeed Venture Partners,2200 Address: c/o Lightspeed Venture Partners,2200
Sand Hill Road, Menlo Park, CA 94025 Sand Hill Road, Menlo Park, CA 94025
Designated Filer: Schaepe, Christopher J. Designated Filer: Schaepe, Christopher J.
Issuer and Ticker Symbol: eHealth, Inc. (EHTH) Issuer and Ticker Symbol: eHealth, Inc. (EHTH)
Date of Event Requiring Statement: October 12, 2006 Date of Event Requiring Statement: October 12, 2006
Name: Weiss, Peck & Greer Venture Associates IV Cayman, LP, Name: WPG VC Fund Adviser, LLC
Address: c/o Lightspeed Venture Partners,2200 Address: c/o Lightspeed Venture Partners,2200
Sand Hill Road, Menlo Park, CA 94025 Sand Hill Road, Menlo Park, CA 94025
Designated Filer: Schaepe, Christopher J. Designated Filer: Schaepe, Christopher J.
Issuer and Ticker Symbol: eHealth, Inc. (EHTH) Issuer and Ticker Symbol: eHealth, Inc. (EHTH)
Date of Event Requiring Statement: October 12, 2006 Date of Event Requiring Statement: October 12, 2006
Name: WPG Information Sciences Entrepreneur Fund, LP Name: WPG VC Fund Adviser II, LLC
Address: c/o Lightspeed Venture Partners,2200 Address: c/o Lightspeed Venture Partners,2200
Sand Hill Road, Menlo Park, CA 94025 Sand Hill Road, Menlo Park, CA 94025
Designated Filer: Schaepe, Christopher J. Designated Filer: Schaepe, Christopher J.
Issuer and Ticker Symbol: eHealth, Inc. (EHTH) Issuer and Ticker Symbol: eHealth, Inc. (EHTH)
Date of Event Requiring Statement: October 12, 2006 Date of Event Requiring Statement: October 12, 2006
Name: Weiss, Peck & Greer Venture Associates V, LLC
Address: c/o Lightspeed Venture Partners,2200
Sand Hill Road, Menlo Park, CA 94025
Designated Filer: Schaepe, Christopher J.
Issuer and Ticker Symbol: eHealth, Inc. (EHTH)
Date of Event Requiring Statement: October 12, 2006
Name: Weiss, Peck & Greer Venture Associates V-A, LLC
Address: c/o Lightspeed Venture Partners,2200
Sand Hill Road, Menlo Park, CA 94025
Designated Filer: Schaepe, Christopher J.
Issuer and Ticker Symbol: eHealth, Inc. (EHTH)
Date of Event Requiring Statement: October 12, 2006
Name: Weiss, Peck & Greer Venture Associates V Cayman, LP
Address: c/o Lightspeed Venture Partners,2200
Sand Hill Road, Menlo Park, CA 94025
Designated Filer: Schaepe, Christopher J.
Issuer and Ticker Symbol: eHealth, Inc. (EHTH)
Date of Event Requiring Statement: October 12, 2006