Sec Form 4 Filing - MORGENTHALER VENTURE PARTNERS IX LP @ Doximity, Inc. - 2021-11-10

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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
MORGENTHALER VENTURE PARTNERS IX LP
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)
(Last) (First) (Middle)
3200 ALPINE ROAD
3. Date of Earliest Transaction (MM/DD/YY)
11/10/2021
(Street)
PORTOLA VALLEY, CA94028
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
_____ Form filed by One Reporting Person
__ X __ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 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 11/10/2021 C( 1 ) 17,070,350 A $ 0 17,070,350 D( 2 )
Class A Common Stock 11/12/2021 J( 3 ) 8,535,175 D $ 0 8,535,175 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 (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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 of Derivative Security: 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
Class B Common Stock ( 4 ) 11/10/2021 C( 1 ) 17,070,350 ( 4 ) ( 4 ) Class A Common Stock 17,070,350 $ 0 0 D( 2 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
MORGENTHALER VENTURE PARTNERS IX LP
3200 ALPINE ROAD
PORTOLA VALLEY, CA94028
X
Morgenthaler Management Partners IX, LLC
3200 ALPINE ROAD
PORTOLA VALLEY, CA94028
X
Signatures
MORGENTHALER VENTURE PARTNERS IX, L.P. By: Morgenthaler Management Partners IX, LLC, its General Partner By: /s/ Travis Boettner, Chef Financial Officer and Chief Compliance Officer 11/12/2021
Signature of Reporting Person Date
MORGENTHALER MANAGEMENT PARTNERS IX, LLC By: /s/ Travis Boettner, Chef Financial Officer and Chief Compliance Officer 11/12/2021
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Conversion of a derivative security in accordance of its terms.
( 2 )These shares are directly held by Morgenthaler Venture Partners IX, L.P. ("Morgenthaler"). Morgenthaler Management Partners IX, LLC ("MMP IX") is the sole general partner of Morgenthaler. MMP IX may be deemed to indirectly beneficially own the shares held by Morgenthaler, and MMP IX disclaims beneficial ownership of such shares, except to the extent of its pecuniary interest therein.
( 3 )Represents a pro-rata, in-kind distribution by Morgenthaler and its affiliated funds, not for additional consideration, to MMP IX and its respective members and assignees.
( 4 )Each share of Class B Common Stock is convertible into one share of Class A Common Stock, par value $0.001 per share (the "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.

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