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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
Schedule 13G
Under the Securities Exchange Act of 1934
(Amendment No. ____________)*
eBenX, Inc.
(Name of Issuer)
Common Stock, $.01 par value
(Title of Class of Securities)
278868 10 8
(CUSIP Number)
September 6, 2000
(Date of Event Which Requires Filing of this Statement)
Check the appropriate box to designate the rule pursuant to which this Schedule
is filed:
[ ] Rule 13d-1(b)
[x] Rule 13d-1(c)
[ ] Rule 13d-1(d)
*The remainder of this cover page shall be filled out for a reporting person's
initial filing on this form with respect to the subject class of securities, and
for any subsequent amendment containing information which would alter the
disclosures provided in a prior cover page.
The information required in the remainder of this cover page shall not be deemed
to be "filed" for the purpose of Section 18 of the Securities Exchange Act of
1934 ("Act") or otherwise subject to the liabilities of that section of the Act
but shall be subject to all other provisions of the Act (however, see the
Notes).
(continued on following page(s))
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SCHEDULE 13G
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CUSIP NO. 278868 10 8
1. NAME OF REPORTING PERSON Jeffrey Rosenblum
I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (entities only) N/A
2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*
(a) [ ]
(b) [ ]
3. SEC USE ONLY
4. CITIZENSHIP OR PLACE OF ORGANIZATION
5. SOLE VOTING POWER 1,503,116 shares
Common Stock.
NUMBER OF
SHARES
BENEFICIALLY 6. SHARED VOTING POWER N/A
OWNED BY
EACH
REPORTING 7. SOLE DISPOSITIVE POWER 1,503,116 shares
Common Stock.
PERSON
WITH
8. SHARED DISPOSITIVE POWER N/A
9. AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
1,503,116 shares Common Stock
10. CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES [X]
Excludes 120,004 shares held in the Jeffrey Rosenblum Irrevocable Trust
and 18,286 shares held in the Jeffrey Rosenblum Guarantor Retained
Annuity Trust the Reporting Person has no voting or dispositive power
over these shares in the Trusts and he disclaims beneficial ownership
of these shares.
11. PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
7.7%
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Page 3 of 4 pages
12. TYPE OF REPORTING PERSON
IN
ITEM 1(a). Name of Issuer
eBenX, Inc.
ITEM 1(b). Address of Issuer's Principal Executive Offices
605 North Highway 169, Suite LL
Minneapolis, MN 55441
ITEM 2(a). Names of Persons Filing
Jeffrey Rosenblum
ITEM 2(b). Address of principal business office
605 North Highway 169, Suite LL
Minneapolis, MN 55441
ITEM 2(c). Citizenship
U.S. Citizen
ITEM 2(d). Title of Class of Securities
Common Stock, $.01 par value
ITEM 2(e). CUSIP Number
278868 10 8
ITEM 3. If this statement is filed pursuant to Rules 13d-1(b), or
13(d)-2(b), check whether the person filing it is a: N/A
ITEM 4. Ownership
(a) The Reporting Person owns 1,503,116 shares of common stock,
$.01 par value, of the Issuer as of September 15, 2000.
(b) Percent of class 7.7%.
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Page 4 of 4 pages
(c) Number of shares as to which such person has:
(i) sole power to vote or to direct the vote 1,503,116.
(ii) shared power to vote or to direct the vote N/A.
(iii) sole power to dispose or to direct the disposition of
1,503,116.
(iv) shared power to dispose or to direct the disposition
of N/A.
ITEM 5. Ownership of Five Percent or Less of a Class
N/A
ITEM 6. Ownership of More than Five Percent on Behalf of Another
Person
N/A
ITEM 7. Identification and Classification of the Subsidiary Which
Acquired the Security Being Reported on By the Parent Holding
Company
N/A
ITEM 8. Identification and Classification of Members of the Group
N/A
ITEM 9. Notice of Dissolution of Group
N/A
ITEM 10. Certification
By signing below I certify that, to the best of my knowledge
and belief, the securities referred to above were not acquired and are not held
for the purpose of or with the effect of changing or influencing the control of
the issuer of the securities and were not acquired and are not held in
connection with or as a participant in any transaction having that purpose or
effect.
After reasonable inquiry and to the best of my knowledge and belief, I
certify that the information set forth in this statement is true, complete and
correct.
Date: September 15, 2000
/s/ Jeffrey Rosenblum
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By: Jeffrey Rosenblum
