Sec Form 4 Filing - INTERWEST PARTNERS X LP @ Doximity, Inc. - 2021-11-12

Insider filing report for Changes in Beneficial Ownership
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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
INTERWEST PARTNERS X 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)
467 FIRST STREET SUITE 201
3. Date of Earliest Transaction (MM/DD/YY)
11/12/2021
(Street)
LOS ALTOS, CA94022
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 11/12/2021 C( 1 ) 4,300,000 A 4,300,000 D( 4 )
Class A Common Stock 11/12/2021 J( 2 ) 4,300,000 D $ 0 0 D
Class A Common Stock 11/12/2021 J( 2 ) 1,089,179 A $ 0 1,089,179 I By: InterWest Management Partners X, LLC( 4 )
Class A Common Stock 11/12/2021 J( 3 ) 1,089,179 D $ 0 0 I By: InterWest Management Partners X, LLC( 4 )
Class A Common Stock 11/12/2021 J( 3 ) 40,626 A $ 0 40,626 I By: Khaled A. Nasr( 4 )
Class A Common Stock 11/12/2021 J( 3 ) 27,229 A $ 0 27,229 I By: Keval Desai( 4 )
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 ( 5 ) 11/12/2021 C( 1 ) 4,300,000 ( 5 ) ( 5 ) Class A Common Stock 4,300,000 $ 0 12,856,998 D( 4 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
INTERWEST PARTNERS X LP
467 FIRST STREET SUITE 201
LOS ALTOS, CA94022
X
InterWest Management Partners X, LLC
467 FIRST STREET, SUITE 201
LOS ALTOS, CA94022
X
NASR KHALED
467 FIRST STREET, SUITE 201
LOS ALTOS, CA94022
X
Desai Keval
467 FIRST STREET, SUITE 201
LOS ALTOS, CA94022
X
Signatures
/s/ Karen A. Wilson, Attorney-in Fact for InterWest Partners X, LP 11/15/2021
Signature of Reporting Person Date
/s/ Karen A. Wilson, Attorney-in Fact for InterWest Management Partners X, LLC 11/15/2021
Signature of Reporting Person Date
/s/ Karen A. Wilson, Attorney-in Fact for Khlaed A. Nasr 11/15/2021
Signature of Reporting Person Date
/s/ Karen A. Wilson, Attorney-in Fact for Keval Desai 11/15/2021
Signature of Reporting Person Date
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 )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.
( 3 )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.
( 4 )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.
( 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 IMP10, is also a Director of the Issuer and has filed a separate Form 4 in his own name.

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