0001213900-20-030538.txt : 20201007 0001213900-20-030538.hdr.sgml : 20201007 20201007175459 ACCESSION NUMBER: 0001213900-20-030538 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20201005 FILED AS OF DATE: 20201007 DATE AS OF CHANGE: 20201007 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Tompkins Mark N. CENTRAL INDEX KEY: 0001455971 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-56036 FILM NUMBER: 201229727 MAIL ADDRESS: STREET 1: APP. 1, VIA GUIDINO 23 CITY: LUGANO-PARADISO STATE: V8 ZIP: 6900 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Augmedix, Inc. CENTRAL INDEX KEY: 0001769804 STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770] IRS NUMBER: 833299164 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2255 GLADES ROAD STREET 2: SUITE 324A CITY: BOCA RATON STATE: FL ZIP: 33431 BUSINESS PHONE: 561-989-2208 MAIL ADDRESS: STREET 1: 2255 GLADES ROAD STREET 2: SUITE 324A CITY: BOCA RATON STATE: FL ZIP: 33431 FORMER COMPANY: FORMER CONFORMED NAME: Malo Holdings Corp DATE OF NAME CHANGE: 20190305 4 1 ownership.xml X0306 4 2020-10-05 0 0001769804 Augmedix, Inc. NONE 0001455971 Tompkins Mark N. APT. 1, VIA GUIDINO 23 LUGANO-PARADISO V8 6900 SWITZERLAND 0 0 0 1 Former Director and 10% Owner Common stock, par value $0.0001 per share 2020-10-05 4 J 0 16667 0 D 4733333 D Common stock, par value $0.0001 per share 2020-10-05 4 J 0 2743333 0 D 1990000 D The reporting person transferred an aggregate of 16,667 shares of the Issuer's common stock as consideration for services rendered to an affiliate of the reporting person by the recipients. Pursuant to the terms of an Agreement and Plan of Merger and Reorganization, dated as of October 5, 2020, by and among the Issuer, August Acquisition Corp. ("Acquisition Sub"), and Augmedix Operating Company (f/k/a Augmedix, Inc.) ("Augmedix"), on October 5, 2020, Acquisition Sub merged with and into Augmedix, with Augmedix continuing as the surviving entity (the "Merger") and as the Issuer's wholly-owned subsidiary. As a condition to the Merger, pursuant to the terms of a stock cancellation agreement, the reporting person voluntarily surrendered and canceled 2,743,333 shares of the Issuer's common stock prior to the consummation of the Merger. The reporting person resigned as a director of the Issuer upon consummation of the Merger. /s/ Mark N. Tompkins 2020-10-07