0000899243-21-044589.txt : 20211115 0000899243-21-044589.hdr.sgml : 20211115 20211115163718 ACCESSION NUMBER: 0000899243-21-044589 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211112 FILED AS OF DATE: 20211115 DATE AS OF CHANGE: 20211115 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: NASR KHALED CENTRAL INDEX KEY: 0001276600 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40508 FILM NUMBER: 211411559 MAIL ADDRESS: STREET 1: 467 FIRST STREET STREET 2: SUITE 201 CITY: LOS ALTOS STATE: X1 ZIP: 94022 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: INTERWEST PARTNERS X LP CENTRAL INDEX KEY: 0001443898 STATE OF INCORPORATION: CA FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40508 FILM NUMBER: 211411561 BUSINESS ADDRESS: STREET 1: C/O INTERWEST PARTNERS STREET 2: 467 FIRST STREET SUITE 201 CITY: LOS ALTOS STATE: CA ZIP: 94022 BUSINESS PHONE: 650-854-8585 MAIL ADDRESS: STREET 1: C/O INTERWEST PARTNERS STREET 2: 467 FIRST STREET SUITE 201 CITY: LOS ALTOS STATE: CA ZIP: 94022 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Desai Keval CENTRAL INDEX KEY: 0001553019 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40508 FILM NUMBER: 211411558 MAIL ADDRESS: STREET 1: 467 FIRST STREET STREET 2: SUITE 201 CITY: LOS ALTOS STATE: X1 ZIP: 94022 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: InterWest Management Partners X, LLC CENTRAL INDEX KEY: 0001460207 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40508 FILM NUMBER: 211411560 BUSINESS ADDRESS: STREET 1: 467 FIRST STREET STREET 2: SUITE 201 CITY: LOS ALTOS STATE: CA ZIP: 94022 BUSINESS PHONE: 650-854-8585 MAIL ADDRESS: STREET 1: 467 FIRST STREET STREET 2: 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 2021-11-12 0 0001516513 Doximity, Inc. DOCS 0001443898 INTERWEST PARTNERS X LP 467 FIRST STREET SUITE 201 LOS ALTOS CA 94022 0 0 1 0 0001460207 InterWest Management Partners X, LLC 467 FIRST STREET, SUITE 201 LOS ALTOS CA 94022 0 0 1 0 0001276600 NASR KHALED 467 FIRST STREET, SUITE 201 LOS ALTOS CA 94022 0 0 1 0 0001553019 Desai Keval 467 FIRST STREET, SUITE 201 LOS ALTOS CA 94022 0 0 1 0 Class A Common Stock 2021-11-12 4 C 0 4300000 A 4300000 D Class A Common Stock 2021-11-12 4 J 0 4300000 0.00 D 0 D Class A Common Stock 2021-11-12 4 J 0 1089179 0.00 A 1089179 I By: InterWest Management Partners X, LLC Class A Common Stock 2021-11-12 4 J 0 1089179 0.00 D 0 I By: InterWest Management Partners X, LLC Class A Common Stock 2021-11-12 4 J 0 40626 0.00 A 40626 I By: Khaled A. Nasr Class A Common Stock 2021-11-12 4 J 0 27229 0.00 A 27229 I By: Keval Desai Class B Common Stock 2021-11-12 4 C 0 4300000 0.00 D Class A Common Stock 4300000 12856998 D 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 1,089,179 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 40,626 shares distributed to Khaled A. Nasr ("Nasr"), 27,229 shares distributed to Keval Desai ("Desai") and 247,074 shares distributed to Gilbert H. Kliman ("Kliman"), as reported on Kliman's separate Form 4 in his own name. These shares are directly held by IW10. IMP10 is the general partner of IW10. Gilbert H. Kliman is the Managing Director of IMP10. Keval Desai and Khaled Nasr are Venture Members of IMP10. Each of IMP10, Gilbert H. Kliman, Keval Desai and Khaled Nasr may be deemed to beneficially own the shares held by IW10, and each of IMP10, Gilbert H. Kliman, Keval Desai and Khaled Nasr disclaims beneficial ownership of only the shares held by IW10, except to the extent of its or 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. Gilbert H. Kliman, a Managing Director of IMP10, is also a Director of the Issuer and has filed a separate Form 4 in his own name. /s/ Karen A. Wilson, Attorney-in Fact for InterWest Partners X, LP 2021-11-15 /s/ Karen A. Wilson, Attorney-in Fact for InterWest Management Partners X, LLC 2021-11-15 /s/ Karen A. Wilson, Attorney-in Fact for Khlaed A. Nasr 2021-11-15 /s/ Karen A. Wilson, Attorney-in Fact for Keval Desai 2021-11-15