0001516513-21-000041.txt : 20211208 0001516513-21-000041.hdr.sgml : 20211208 20211208165449 ACCESSION NUMBER: 0001516513-21-000041 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211112 FILED AS OF DATE: 20211208 DATE AS OF CHANGE: 20211208 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Tangney Jeffrey CENTRAL INDEX KEY: 0001863328 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-40508 FILM NUMBER: 211479308 MAIL ADDRESS: STREET 1: C/O DOXIMITY, INC. STREET 2: 500 3RD STREET SUITE 510 CITY: SAN FRANCISCO STATE: CA ZIP: 94107 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Tangney Schweikert Family Trust CENTRAL INDEX KEY: 0001868242 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-40508 FILM NUMBER: 211479307 BUSINESS ADDRESS: STREET 1: C/O DOXIMITY, INC. STREET 2: 500 3RD STREET, SUITE 510 CITY: SAN FRANCISCO STATE: CA ZIP: 94107 BUSINESS PHONE: 650-549-4330 MAIL ADDRESS: STREET 1: C/O DOXIMITY, INC. STREET 2: 500 3RD STREET, SUITE 510 CITY: SAN FRANCISCO STATE: CA ZIP: 94107 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Tangney Annuity Trust, LLC CENTRAL INDEX KEY: 0001867907 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-40508 FILM NUMBER: 211479306 BUSINESS ADDRESS: STREET 1: C/O DOXIMITY, INC. STREET 2: 500 3RD STREET, SUITE 510 CITY: SAN FRANCISCO STATE: CA ZIP: 94107 BUSINESS PHONE: 650-549-4330 MAIL ADDRESS: STREET 1: C/O DOXIMITY, INC. STREET 2: 500 3RD STREET, SUITE 510 CITY: SAN FRANCISCO STATE: CA ZIP: 94107 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/A 1 wf-form4a_163900047737590.xml FORM 4/A X0306 4/A 2021-11-12 2021-11-19 0 0001516513 Doximity, Inc. DOCS 0001863328 Tangney Jeffrey DOXIMITY, INC. 500 THIRD STREET SAN FRANCISCO CA 94107 1 1 1 0 Chief Executive Officer 0001868242 Tangney Schweikert Family Trust C/O DOXIMITY, INC. 500 THIRD STREET SAN FRANCISCO CA 94107 0 0 1 0 0001867907 Tangney Annuity Trust, LLC C/O DOXIMITY, INC. 500 THIRD STREET SAN FRANCISCO CA 94107 0 0 1 0 Class A Common Stock 2021-11-12 4 C 0 100000 A 100000 D Class A Common Stock 2021-11-12 4 C 0 150000 A 150000 I By Tangney Schweikert Family Trust Class B Common Stock 2021-11-12 4 C 0 100000 0 D Class A Common Stock 100000.0 6321666 D Class B Common Stock 2021-11-12 4 C 0 150000 0 D Class A Common Stock 150000.0 24203330 I By Tangney Schweikert Family Trust 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. This Form 4/A is being filed to include this transaction, which was inadvertently omitted from the Forms 4 and 4/A filed by Jeffrey Tangney on November 19, 2021. These shares are owned directly by Mr. Tangney. These shares are owned directly by the Tangney Schweikert Family Trust, a ten percent owner of the Issuer, and indirectly by Mr. Tangney as trustee of such trust. Mr. Tangney is an officer, director and ten percent owner of the Issuer. 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 Issuer's initial public offering; 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. /s/ Jennifer Chaloemtiarana, Attorney-in-Fact for Jeffrey Tangney 2021-12-08 /s/ Jennifer Chaloemtiarana, Attorney-in-Fact for Tangney Schweikert Family Trust 2021-12-08 /s/ Jennifer Chaloemtiarana, Attorney-in-Fact for Tangney Annuity Trust, LLC 2021-12-08