SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response: 0.5
  
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
DCM VI, L.P.

(Last) (First) (Middle)
2420 SAND HILL ROAD
SUITE 200

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Augmedix, Inc. [ NONE ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
10/05/2020
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 10/05/2020 A 3,064,751 A (1) 3,064,751 D(2)
Common Stock 10/05/2020 P 666,667 A $3 3,731,418 D(2)
Common Stock 10/05/2020 A 20,007 A (1) 20,007 I See footnote(3)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Warrant (right to buy) $2.88 10/05/2020 A 269,490 (4) 09/02/2029 Common Stock 269,490 (1) 269,490 D(2)
1. Name and Address of Reporting Person*
DCM VI, L.P.

(Last) (First) (Middle)
2420 SAND HILL ROAD
SUITE 200

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
1. Name and Address of Reporting Person*
A-Fund, L.P.

(Last) (First) (Middle)
2420 SAND HILL ROAD
SUITE 200

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
Explanation of Responses:
1. On October 5, 2020, the Issuer's wholly-owned subsidiary, August Acquisition Corp. ("Acquisition Sub"), merged with and into Augmedix, Inc., a privately held Delaware corporation ("Augmedix"). Pursuant to this transaction (the "Merger"), Augmedix was the surviving corporation and became the Issuer's wholly owned subsidiary. All of the outstanding shares of stock of Augmedix held by accredited investors were converted into shares of the Issuer's common stock. All of the outstanding warrants, options and stock appreciation rights of Augmedix were assumed by the Issuer.
2. These securities are held of record by DCM VI, L.P. ("DCM VI"). Jason Krikorian, a member of the Issuer's board of directors, is a general partner at DCM, which is an affiliate of DCM VI.
3. These securities are held of record by A-Fund, L.P. ("A-Fund"). Jason Krikorian, a member of the Issuer's board of directors, is a general partner at DCM, which is an affiliate of A-Fund.
4. The warrants are fully vested and exerciseable.
Remarks:
DCM VI, L.P. By /s/ Matthew Bonner, Chief Operating Officer & Legal Partner A-FUND, L.P. By /s/ Matthew Bonner, Chief Operating Officer & Legal Partner 10/07/2020
** 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 4 (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.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.