Sec Form 4 Filing - Kliman Gilbert H @ Doximity, Inc. - 2021-12-02

Insider filing report for Changes in Beneficial Ownership
"Insiders might sell their shares for any number of reasons, but they buy them for only one: they think the price will rise"
- Peter Lynch
What is insider trading>>
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
OMB APPROVAL
OMB Number: 3235-0287
Expires: November 30, 2011
Estimated average burden hours per response... 0.5
1. Name and Address of Reporting Person
Kliman Gilbert H
2. Issuer Name and Ticker or Trading Symbol
Doximity, Inc. [ DOCS]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
C/O INTERWEST PARTNERS, 467 FIRST STREET SUITE 201
3. Date of Earliest Transaction (MM/DD/YY)
12/02/2021
(Street)
LOS ALTOS, CA94022
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ 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 12/02/2021 C( 1 ) 4,300,000 A 4,300,000 I By InterWest Partners X, L.P.( 4 )
Class A Common Stock 12/02/2021 J( 2 ) 4,300,000 D $ 0 0 I By InterWest Partners X, L.P.( 4 )
Class A Common Stock 12/02/2021 J( 2 ) 1,101,094 A $ 0 1,101,094 I By: InterWest Management Partners X, LLC( 4 )
Class A Common Stock 12/02/2021 J( 3 ) 1,101,094 D $ 0 0 I By: InterWest Management Partners X, LLC( 4 )
Class A Common Stock 12/02/2021 J( 3 ) 249,778 A $ 0 496,852 D
Class A Common Stock 12/03/2021 S 2,000 D $ 65.8245( 6 ) 494,852 D
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 ) 12/02/2021 C( 1 ) 4,300,000 ( 5 ) ( 5 ) Class A Common Stock 4,300,000 $ 0 8,556,998 I By InterWest Partners X, L.P.( 4 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Kliman Gilbert H
C/O INTERWEST PARTNERS
467 FIRST STREET SUITE 201
LOS ALTOS, CA94022
X X
Signatures
/s/ Karen A. Wilson, Attorney-in Fact for Gilbert H. Kliman 12/06/2021
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 1,101,094 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 249,778 shares distributed to Gilbert H. Kliman ("Kliman").
( 4 )These shares are directly held by IW10. IMP10, as the general partner of IW10, may be deemed to beneficially own the shares held by IW10. The Reporting Person is the Managing Director of IMP10, and as such may be deemed to beneficially own the shares held by IW10. The Reporting Person disclaims beneficial ownership of such shares, except to the extent of 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.
( 6 )The price represents the weighted-average price of the shares sold in multiple transactions ranging from $64.10 to $66.27 per share, inclusive. The Reporting Person undertakes to provide the Issuer, a security holder of the Issuer, or the Staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the range set forth in this footnote.

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).

Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.