Initial Statement of Beneficial Ownership (3)
November 09 2021 - 4:28PM
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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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
*
Witkowski Michael S. |
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) Chief Compliance Officer / |
(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 | 96771 | (1) | D | |
Explanation of Responses: |
(1) | Mr. Witkowski holds 50 Options, each exercisable for $2,097 into 645.1452 shares of Common Stock. Of such 50 Options, none are vested and vest in four equal annual installments beginning on July 15, 2023. These 50 Options were granted December 10, 2020 and expire December 9, 2030, 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. Mr. Witkowski holds an additional 100 Options, each exercisable for $1,023 into 645.1452 shares of Common Stock. Of such 100 Options, 25 Options remain unvested and vest in full on July 15, 2022. These 100 Options were granted December 31, 2019 and expire December 30, 2029, 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 |
Witkowski Michael S. 35 WEST 35TH STREET, FLOOR 5 NEW YORK, NY 10001 |
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| Chief Compliance Officer |
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Signatures
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Mike Witkowski by Andre Oberholzer as Attorney-in-Fact /s/ Andre Oberholzer | | 11/9/2021 |
**Signature of Reporting Person | Date |
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