Initial Statement of Beneficial Ownership (3)
November 09 2021 - 4:20PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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0.5
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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
*
Capone Anthony |
2. Date of Event Requiring Statement (MM/DD/YYYY)
11/5/2021
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3. Issuer Name and Ticker or Trading Symbol
DocGo Inc. [DCGO]
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(Last)
(First)
(Middle)
35 WEST 35TH STREET, FLOOR 5 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner ___X___ Officer (give title below) _____ Other (specify below) President / |
(Street)
NEW YORK, NY 10001
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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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) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: 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 |
Options to Purchase Common Stock | (1) | (1) | Common Stock | 645145 | (1) | D | |
Explanation of Responses: |
(1) | Mr. Capone holds 1000 Options to purchase Common Stock, each exercisable for $1,460 into 645.1452 shares of Common Stock. 200 Options are unvested and vest in full on Jan. 23, 2022. These 1000 Options were granted January 23, 2017 and expire January 22, 2027, in each case, as subject to the terms of the Option Agreement entered into with Ambulnz Inc. and assumed by DocGo Inc. on November 5, 2021. |
Remarks: Exhibit 24 - Power of Attorney |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Capone Anthony 35 WEST 35TH STREET, FLOOR 5 NEW YORK, NY 10001 |
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| President |
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Signatures
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Antony Capone by Andre Oberholzer as Attorney-in-Fact for /s/ Andre Oberholzer | | 11/9/2021 |
**Signature of Reporting Person | Date |
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