0001516513-23-000040.txt : 20230526 0001516513-23-000040.hdr.sgml : 20230526 20230526213131 ACCESSION NUMBER: 0001516513-23-000040 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230524 FILED AS OF DATE: 20230526 DATE AS OF CHANGE: 20230526 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Tangney Jeffrey CENTRAL INDEX KEY: 0001863328 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40508 FILM NUMBER: 23971213 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 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40508 FILM NUMBER: 23971211 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 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40508 FILM NUMBER: 23971212 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 1 wf-form4_168515107416470.xml FORM 4 X0407 4 2023-05-24 0 0001516513 Doximity, Inc. DOCS 0001863328 Tangney Jeffrey DOXIMITY, INC. 500 THIRD STREET SAN FRANCISCO CA 94107 1 1 1 0 Chief Executive Officer 0001867907 Tangney Annuity Trust, LLC C/O DOXIMITY, INC. 500 THIRD STREET SAN FRANCISCO CA 94107 0 0 1 0 0001868242 Tangney Schweikert Family Trust C/O DOXIMITY, INC. 500 THIRD STREET SAN FRANCISCO CA 94107 0 0 1 0 0 Class B Common Stock 2023-05-24 4 G 0 1400070 0 A Class A Common Stock 1400070.0 20000000 I By Tangney Annuity Trust, LLC Class B Common Stock 2023-05-24 4 G 0 7940598 0 A Class A Common Stock 7940598.0 20000000 I By Tangney Annuity Trust, LLC Class B Common Stock Class A Common Stock 24203330.0 24203330 I By Tangney Schweikert Family Trust Class B Common Stock Class A Common Stock 6171666.0 6171666 D 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. On May 24, 2023, in connection with the termination of the Tangney Annuity Trust ("TAT"), a grantor retained annuity trust, in accordance with its terms, TAT distributed, for no consideration, all of its ownership in the Tangney Annuity Trust, LLC ("TAT LLC") to Jeffrey Tangney in the form of a final annuity payment that was exempt from Section 16 pursuant to Rule 16a-13 under the Securities and Exchange Act of 1934, as amended, with the remainder interest being distributed to (i) the Tangney Exempt Gift Trust (the "Exempt Trust"), for the benefit of Mr. Tangney's spouse, Claudia Schweikert, and their children, and (ii) the Tangney Non-Exempt Gift Trust ("Non-Exempt Trust"), for the benefit of Claudia Schweikert and their children. Shares held directly by TAT LLC represented by the interest in TAT LLC that was distributed by TAT to the Exempt Trust. TAT LLC directly holds 20,000,000 shares, representing (i) 7,724,822 shares held directly by TAT LLC represented by the interest in TAT LLC that was distributed to Mr. Tangney pursuant to the final annuity payment by TAT, (ii) 2,934,510 shares held directly by TAT LLC represented by Mr. Tangney's direct interest in TAT LLC prior to the transactions reported herein, and (iii) the shares reported in column 5 described in footnotes 3 and 6 hereto. No shares held directly by TAT LLC have been transferred as a result of the transactions reported herein. These shares are owned directly by TAT LLC over which Claudia Schweikert has sole voting and dispositive power. Mr. Tangney disclaims beneficial ownership over the shares held by TAT LLC, except to the extent, if any, of his pecuniary interest therein, and nothing in this report shall be deemed an admission that Mr. Tangney has beneficial ownership over any such shares for Section 16 purposes or otherwise. Shares held directly by TAT LLC represented by the interest in TAT LLC that was distributed by TAT to the Non-Exempt Trust. 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. /s/ Jennifer Chaloemtiarana, Attorney-in-Fact for Jeffrey Tangney 2023-05-26 /s/ Jennifer Chaloemtiarana, Attorney-in-Fact for Tangney Annuity Trust, LLC 2023-05-26 /s/ Jennifer Chaloemtiarana, Attorney-in-Fact for Tangney Schweikert Family Trust 2023-05-26