Sec Form 3 Filing - Jorgensen Paul W. @ Doximity, Inc. - 2022-03-22

Insider filing report for Changes in Beneficial Ownership
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FORM 3
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
Jorgensen Paul W.
2. Issuer Name and Ticker or Trading Symbol
Doximity, Inc. [ DOCS]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
X __ Officer (give title below) _____ Other (specify below)
Chief Revenue Officer
(Last) (First) (Middle)
DOXIMITY, INC., 500 THIRD STREET
3. Date of Earliest Transaction (MM/DD/YY)
03/22/2022
(Street)
SAN FRANCISCO, CA94107
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 182,676 D
Class A Common Stock 62,593( 1 ) D
Class A Common Stock 62,593( 2 ) 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
Stock Option (Right to Buy) $ 0.82 ( 3 ) 08/28/2027 Class B Common Stock( 4 ) 31,245 D
Stock Option (Right to Buy) $ 0.82 ( 5 ) 08/28/2027 Class B Common Stock( 4 ) 60,407 D
Stock Option (Right to Buy) $ 1.09 ( 6 ) 02/12/2029 Class B Common Stock( 4 ) 55,584 D
Stock Option (Right to Buy) $ 1.5 ( 7 ) 08/27/2029 Class B Common Stock( 4 ) 10,080 D
Stock Option (Right to Buy) $ 2.21 ( 8 ) 09/01/2030 Class B Common Stock( 4 ) 146,668 D
Stock Option (Right to Buy) $ 12.56 ( 9 ) 05/06/2031 Class B Common Stock( 4 ) 38,500 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Jorgensen Paul W.
DOXIMITY, INC.
500 THIRD STREET
SAN FRANCISCO, CA94107
Chief Revenue Officer
Signatures
/s/ Jennifer Chaloemtiarana, Attorney-in-Fact 04/01/2022
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Represents restricted stock units ("RSUs") granted on February 15, 2022, which vest in 16 equal quarterly installments following February 15, 2022, subject to the Reporting Person's continuous service relationship with the Issuer through each applicable vesting date.
( 2 )Represents RSUs granted on February 15, 2022, which fully vest on December 31, 2024, subject to the Reporting Person's continuous service relationship with the Issuer on such vesting date.
( 3 )The stock option vests subject to a time-based and performance-based vesting schedule. The stock option vests in part upon the achievement of certain performance goals in 2018. Upon determination by the Issuer's Board of Directors (the "Board") that such performance goals were met, the stock option vests in 48 equal monthly installments after February 13, 2019, subject to the Reporting Person's continuous service relationship with the Issuer through each applicable vesting date. The stock option was granted on August 29, 2017.
( 4 )Each share of Class B Common Stock, par value $0.001 per share (the "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 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 )The stock option vests subject to a time-based and performance-based vesting schedule. The stock option vests in part upon the achievement of certain performance goals in 2019. Upon determination by the Board that such performance goals were met, the stock option vests in 48 equal monthly installments after March 27, 2020, subject to the Reporting Person's continuous service relationship with the Issuer through each applicable vesting date. The stock option was granted on August 29, 2017.
( 6 )The stock option vests subject to a time-based and performance-based vesting schedule. The stock option vests in part upon the achievement of certain performance goals in 2020. Upon determination by the Board that such performance goals were met, the stock option vests in 48 equal monthly installments after March 27, 2020, subject to the Reporting Person's continuous service relationship with the Issuer through each applicable vesting date. The stock option was granted on February 13, 2019.
( 7 )The stock option vests in 48 equal monthly installments after August 28, 2019, subject to the Reporting Person's continuous service relationship with the Issuer through each applicable vesting date. The stock option was granted on August 28, 2019.
( 8 )The stock option vests in 48 equal monthly installments after July 1, 2020, subject to the Reporting Person's continuous service relationship with the Issuer through each applicable vesting date. The stock option was granted on September 2, 2020.
( 9 )The stock option vests in 48 equal monthly installments after May 1, 2021, subject to the Reporting Person's continuous service relationship with the Issuer through each applicable vesting date. The stock option was granted on May 7, 2021.

Remarks:
Exhibit 24 - Power of Attorney

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