SEC FORM 3/A 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*
Fillo Christopher

(Last) (First) (Middle)
35 WEST 35TH STREET, FLOOR 5

(Street)
NEW YORK NY 10001

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
11/05/2021
3. Issuer Name and Ticker or Trading Symbol
DocGo Inc. [ DCGO ]
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)
11/09/2021
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 4,530,990 I By 1868 Univeritas Fund LP(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
Options to Purchase Common Stock (2) (2) Common Stock 32,902 (2) I By 1868 Univeritas Fund LP(1)
Explanation of Responses:
1. The general partner of 1868 Univeritas Fund LP ("Univeritas Fund") is 1868 Univeritas GP, LLC ("Univeritas GP"). Mr. Fillo is an officer of and controls Univeritas GP and may be deemed the beneficial owner of the securities held by Univeritas Fund.
2. Univeritas Fund holds 51 Options to purchase Common Stock, each exercisable for $5,200 into 645.1452 shares of Common Stock. 34 Options are unvested and vest in two equal annual installments beginning on January 1, 2022. These 51 Options were granted March 19, 2021 and expire March 18, 2031, 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:
This Form 3/A is to amend the Form 3 filed on November 9, 2021 to reflect indirect beneficial ownership of the reporting person.
Chris Fillo by Andre Oberholzer as Attorney-in-Fact /s/ Andre Oberholzer 11/12/2021
** 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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