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*
JACOBSON HARRY R

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

(Street)
BURLINGTON MA 01803

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/27/2003
3. Issuer Name and Ticker or Trading Symbol
HEALTHGATE DATA CORP [ HGAT ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. 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 Beneficially Owned
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 55,556 D
Common Stock 115,700 I by EBM Solutions, Inc.(1)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
Stock Options 10/27/2003 10/27/2008 Common Stock 35,000(3) $0.7 D
Common Stock Warrant 10/27/2003 04/27/2005 Common Stock 51,282 $1.2 I by EBM Solutions, Inc.(2)
Explanation of Responses:
1. Represents shares of the issuer held by EBM Solutions, Inc. and such shares are expected to be distributed to the reporting person upon EBM Solutions, Inc.'s anticipated liquidation. The reporting person is a director and shareholder of EBM Solutions, Inc. The reporting person disclaims beneficial ownership of the other 636,348 shares of the issuer which are held by EBM Solutions, Inc. 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.
2. Represents shares of common stock issuable under a warrant of the issuer held by EBM Solutions, Inc. and such warrants are expected to be distributed to the reporting person upon EBM Solutions, Inc's anticipated liquidation. The reporting person is a director and shareholder of EBM Solutions, Inc. 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 Solutions, Inc. 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. Subject to vesting
/s/ Harry R. Jacobson 10/27/2003
** 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 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.
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