SEC FORM 3

SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
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.

(Last)

(First)

(Middle)

DOXIMITY, INC.

500 THIRD STREET

(Street)

SAN FRANCISCO

94107

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
03/22/2022

3. Issuer Name and Ticker or Trading Symbol
Doximity, Inc. [ DOCS ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

	Director	10% Owner
X	Officer (give title below)	Other (specify below)
	Chief Revenue Officer

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)
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 Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
Stock Option (Right to Buy)	⁽³⁾	08/28/2027	Class B Common Stock⁽⁴⁾	31,245	$0.82	D
Stock Option (Right to Buy)	⁽⁵⁾	08/28/2027	Class B Common Stock⁽⁴⁾	60,407	$0.82	D
Stock Option (Right to Buy)	⁽⁶⁾	02/12/2029	Class B Common Stock⁽⁴⁾	55,584	$1.09	D
Stock Option (Right to Buy)	⁽⁷⁾	08/27/2029	Class B Common Stock⁽⁴⁾	10,080	$1.5	D
Stock Option (Right to Buy)	⁽⁸⁾	09/01/2030	Class B Common Stock⁽⁴⁾	146,668	$2.21	D
Stock Option (Right to Buy)	⁽⁹⁾	05/06/2031	Class B Common Stock⁽⁴⁾	38,500	$12.56	D

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

	/s/ Jennifer Chaloemtiarana, Attorney-in-Fact	04/01/2022
	** Signature of Reporting Person	Date
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 5 (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.