Sec Form 4/A Filing - Tangney Jeffrey @ Doximity, Inc. - 2021-11-17

Insider filing report for Changes in Beneficial Ownership
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FORM 4/A
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
Tangney Jeffrey
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
X __ Officer (give title below) _____ Other (specify below)
Chief Executive Officer
(Last) (First) (Middle)
DOXIMITY, INC., 500 THIRD STREET
3. Date of Earliest Transaction (MM/DD/YY)
11/17/2021
(Street)
SAN FRANCISCO, CA94107
4. If Amendment, Date Original Filed (MM/DD/YY)
11/19/2021
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 11/17/2021 C( 1 ) 110,000 A 110,000 I By Tangney Schweikert Family Trust( 2 )
Class A Common Stock 11/17/2021 G 110,000( 3 ) D $ 0 0 I By Tangney Schweikert Family Trust( 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 ) 11/17/2021 C( 1 ) 110,000 ( 4 ) ( 4 ) Class A Common Stock 110,000 $ 0 24,353,330 I By Tangney Schweikert Family Trust( 2 )
Class B Common Stock ( 4 ) ( 4 ) ( 4 ) Class A Common Stock 20,000,000 20,000,000 I By Tangney Annuity Trust, LLC( 5 )
Class B Common Stock ( 4 ) ( 4 ) ( 4 ) Class A Common Stock 6,421,666 6,421,666 D( 6 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Tangney Jeffrey
DOXIMITY, INC.
500 THIRD STREET
SAN FRANCISCO, CA94107
X X Chief Executive Officer
Tangney Schweikert Family Trust
C/O DOXIMITY, INC.
500 THIRD STREET
SAN FRANCISCO, CA94107
X
Tangney Annuity Trust, LLC
C/O DOXIMITY, INC.
500 THIRD STREET
SAN FRANCISCO, CA94107
X
Signatures
/s/ Jennifer Chaloemtiarana, Attorney-in-Fact for Jeffrey Tangney 11/19/2021
Signature of Reporting Person Date
/s/ Jennifer Chaloemtiarana, Attorney-in-Fact for Tangney Schweikert Family Trust 11/19/2021
Signature of Reporting Person Date
/s/ Jennifer Chaloemtiarana, Attorney-in-Fact for Tangney Annuity Trust, LLC 11/19/2021
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 )These shares are owned directly by the Tangney Schweikert Family Trust, a ten percent owner of the Issuer, and indirectly by Jeffrey Tangney as trustee of such trust. Mr. Tangney is an officer, director and ten percent owner of the Issuer.
( 3 )Represents a bona fide gift of shares of Class A Common Stock to a charitable donor advised fund.
( 4 )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.
( 5 )These shares are owned directly by Tangney Annuity Trust, LLC, a ten percent owner of the Issuer, and indirectly by Mr. Tangney as trustee of such trust.
( 6 )These shares are owned directly by Mr. Tangney.

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