SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
INTERWEST PARTNERS X LP

(Last) (First) (Middle)
C/O INTERWEST PARTNERS
467 FIRST STREET, SUITE 201

(Street)
LOS ALTOS CA 94022

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Doximity, Inc. [ DOCS ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
06/28/2021
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Class A Common Stock 06/28/2021 C(1) 4,289,250 A (1) 4,289,250 D(2)
Class A Common Stock 06/28/2021 S(3) 4,289,250 D $24.57 0 D(2)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Series A Preferred Stock (4) 06/28/2021 C 13,296,504 (4) (4) Class B Common Stock(5) 13,296,504 $0 0 D(2)
Series B Preferred Stock (4) 06/28/2021 C 5,412,972 (4) (4) Class B Common Stock(5) 5,412,972 $0 0 D(2)
Series C Preferred Stock (4) 06/28/2021 C 2,736,772 (4) (4) Class B Common Stock(5) 2,736,772 $0 0 D(2)
Class B Common Stock (5) 06/28/2021 C(4) 21,446,248 (5) (5) Class A Common Stock 21,446,248 $0 21,446,248 D(2)
Class B Common Stock (5) 06/28/2021 C(1) 4,289,250 (5) (5) Class A Common Stock 4,289,250 $0 17,156,998 D(2)
1. Name and Address of Reporting Person*
INTERWEST PARTNERS X LP

(Last) (First) (Middle)
C/O INTERWEST PARTNERS
467 FIRST STREET, SUITE 201

(Street)
LOS ALTOS CA 94022

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
InterWest Management Partners X, LLC

(Last) (First) (Middle)
C/O INTERWEST PARTNERS
467 FIRST STREET, SUITE 201

(Street)
LOS ALTOS CA 94022

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
Desai Keval

(Last) (First) (Middle)
C/O INTERWEST PARTNERS
467 FIRST STREET, SUITE 201

(Street)
LOS ALTOS CA 94022

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
NASR KHALED

(Last) (First) (Middle)
C/O INTERWEST PARTNERS
467 FIRST STREET, SUITE 201

(Street)
LOS ALTOS CA 94022

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
Explanation of Responses:
1. 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.
2. These shares are directly held by InterWest Partners X, L.P. ("InterWest"). InterWest Management Partners X, LLC ("IMP X") is the general partner of InterWest. Gilbert H. Kliman is the Managing Director of IMP X. Keval Desai and Khaled Nasr are Venture Members of IMP X. Each of IMP X, Gilbert H. Kliman, Keval Desai and Khaled Nasr may be deemed to beneficially own the shares held by InterWest, and each of IMP X, Gilbert H. Kliman, Keval Desai and Khaled Nasr disclaims beneficial ownership of such shares, except to the extent of its or his pecuniary interest therein.
3. These shares were sold by InterWest in connection with the Issuer's initial public offering ("IPO") at a net price per share of $24.57 (after underwriting discounts and commissions). InterWest was a selling stockholder in the IPO.
4. Each share of Series A Preferred Stock, Series B Preferred Stock and Series C Preferred Stock (collectively, the "Preferred Stock") automatically converted into one share of Class B Common Stock on a one-for-one basis, immediately prior to the closing of the IPO. The shares of Preferred Stock have no expiration date.
5. 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.
Remarks:
Gilbert H. Kliman, a Managing Director of IMP X, 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, L.P. 06/28/2021
/s/ Karen A. Wilson, Attorney-in-Fact for InterWest Management Partners X, LLC 06/28/2021
/s/ Karen A. Wilson, Attorney-in-Fact for Keval Desai 06/28/2021
/s/ Karen A. Wilson, Attorney-in-Fact for Khaled Nasr 06/28/2021
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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