0000899243-21-047010.txt : 20211206
0000899243-21-047010.hdr.sgml : 20211206
20211206200511
ACCESSION NUMBER: 0000899243-21-047010
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211202
FILED AS OF DATE: 20211206
DATE AS OF CHANGE: 20211206
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Kliman Gilbert H
CENTRAL INDEX KEY: 0001293171
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40508
FILM NUMBER: 211474403
MAIL ADDRESS:
STREET 1: C/O INTERWEST PARTNERS
STREET 2: 467 FIRST STREET SUITE 201
CITY: LOS ALTOS
STATE: CA
ZIP: 94022
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Doximity, Inc.
CENTRAL INDEX KEY: 0001516513
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROGRAMMING SERVICES [7371]
IRS NUMBER: 272485512
STATE OF INCORPORATION: DE
FISCAL YEAR END: 0331
BUSINESS ADDRESS:
STREET 1: 500 THIRD STREET
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94107
BUSINESS PHONE: (650) 549-4330
MAIL ADDRESS:
STREET 1: 500 THIRD STREET
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94107
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2021-12-02
0
0001516513
Doximity, Inc.
DOCS
0001293171
Kliman Gilbert H
C/O INTERWEST PARTNERS
467 FIRST STREET SUITE 201
LOS ALTOS
CA
94022
1
0
1
0
Class A Common Stock
2021-12-02
4
C
0
4300000
A
4300000
I
By InterWest Partners X, L.P.
Class A Common Stock
2021-12-02
4
J
0
4300000
0.00
D
0
I
By InterWest Partners X, L.P.
Class A Common Stock
2021-12-02
4
J
0
1101094
0.00
A
1101094
I
By: InterWest Management Partners X, LLC
Class A Common Stock
2021-12-02
4
J
0
1101094
0.00
D
0
I
By: InterWest Management Partners X, LLC
Class A Common Stock
2021-12-02
4
J
0
249778
0.00
A
496852
D
Class A Common Stock
2021-12-03
4
S
0
2000
65.8245
D
494852
D
Class B Common Stock
2021-12-02
4
C
0
4300000
0.00
D
Class A Common Stock
4300000
8556998
I
By InterWest Partners X, L.P.
Each share of Class B Common Stock, par value $0.001 per share (the "Class B Common Stock"), converted into one share of Class A Common Stock, par value $0.001 per share (the "Class A Common Stock"), at the option of the holder.
Represents pro rata in-kind distribution by InterWest Partners X, LP ("IW10") without consideration to its limited and general partners in accordance with the terms of the InterWest Partners X, LP Limited Partnership Agreement. Includes 1,101,094 shares distributed to InterWest Management Partners X, LLC ("IMP10") its general partner.
Represents pro rata in-kind distribution by IMP10 without consideration to its members in accordance with the terms of the InterWest Management Partners X, LLC Operating Agreement. Includes 249,778 shares distributed to Gilbert H. Kliman ("Kliman").
These shares are directly held by IW10. IMP10, as the general partner of IW10, may be deemed to beneficially own the shares held by IW10. The Reporting Person is the Managing Director of IMP10, and as such may be deemed to beneficially own the shares held by IW10. The Reporting Person disclaims beneficial ownership of such shares, except to the extent of his pecuniary interest therein.
Each share of Class B Common Stock is convertible into one share of Class A Common Stock at any time at the option of the holder. Each share of Class B Common Stock held by the Reporting Person will automatically convert into one share of Class A Common Stock, upon the following: (1) the sale or transfer of such share of Class B Common Stock, except for certain permitted transfers described in the Issuer's amended and restated certificate of incorporation; (2) the death or incapacity of the Reporting Person; and (3) on the final conversion date, defined as the earlier of (a) the tenth anniversary of the effectiveness of the registration statement in connection with the IPO; or (b) the date specified by a vote of the holders of at least 66 2/3% of the outstanding shares of Class B Common Stock, voting as a single class.
The price represents the weighted-average price of the shares sold in multiple transactions ranging from $64.10 to $66.27 per share, inclusive. The Reporting Person undertakes to provide the Issuer, a security holder of the Issuer, or the Staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the range set forth in this footnote.
/s/ Karen A. Wilson, Attorney-in Fact for Gilbert H. Kliman
2021-12-06