0000899243-21-044589.txt : 20211115
0000899243-21-044589.hdr.sgml : 20211115
20211115163718
ACCESSION NUMBER: 0000899243-21-044589
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211112
FILED AS OF DATE: 20211115
DATE AS OF CHANGE: 20211115
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: NASR KHALED
CENTRAL INDEX KEY: 0001276600
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40508
FILM NUMBER: 211411559
MAIL ADDRESS:
STREET 1: 467 FIRST STREET
STREET 2: SUITE 201
CITY: LOS ALTOS
STATE: X1
ZIP: 94022
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: INTERWEST PARTNERS X LP
CENTRAL INDEX KEY: 0001443898
STATE OF INCORPORATION: CA
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40508
FILM NUMBER: 211411561
BUSINESS ADDRESS:
STREET 1: C/O INTERWEST PARTNERS
STREET 2: 467 FIRST STREET SUITE 201
CITY: LOS ALTOS
STATE: CA
ZIP: 94022
BUSINESS PHONE: 650-854-8585
MAIL ADDRESS:
STREET 1: C/O INTERWEST PARTNERS
STREET 2: 467 FIRST STREET SUITE 201
CITY: LOS ALTOS
STATE: CA
ZIP: 94022
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Desai Keval
CENTRAL INDEX KEY: 0001553019
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40508
FILM NUMBER: 211411558
MAIL ADDRESS:
STREET 1: 467 FIRST STREET
STREET 2: SUITE 201
CITY: LOS ALTOS
STATE: X1
ZIP: 94022
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: InterWest Management Partners X, LLC
CENTRAL INDEX KEY: 0001460207
STATE OF INCORPORATION: CA
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40508
FILM NUMBER: 211411560
BUSINESS ADDRESS:
STREET 1: 467 FIRST STREET
STREET 2: SUITE 201
CITY: LOS ALTOS
STATE: CA
ZIP: 94022
BUSINESS PHONE: 650-854-8585
MAIL ADDRESS:
STREET 1: 467 FIRST STREET
STREET 2: SUITE 201
CITY: LOS ALTOS
STATE: CA
ZIP: 94022
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Doximity, Inc.
CENTRAL INDEX KEY: 0001516513
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROGRAMMING SERVICES [7371]
IRS NUMBER: 272485512
STATE OF INCORPORATION: DE
FISCAL YEAR END: 0331
BUSINESS ADDRESS:
STREET 1: 500 THIRD STREET
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94107
BUSINESS PHONE: (650) 549-4330
MAIL ADDRESS:
STREET 1: 500 THIRD STREET
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94107
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2021-11-12
0
0001516513
Doximity, Inc.
DOCS
0001443898
INTERWEST PARTNERS X LP
467 FIRST STREET SUITE 201
LOS ALTOS
CA
94022
0
0
1
0
0001460207
InterWest Management Partners X, LLC
467 FIRST STREET, SUITE 201
LOS ALTOS
CA
94022
0
0
1
0
0001276600
NASR KHALED
467 FIRST STREET, SUITE 201
LOS ALTOS
CA
94022
0
0
1
0
0001553019
Desai Keval
467 FIRST STREET, SUITE 201
LOS ALTOS
CA
94022
0
0
1
0
Class A Common Stock
2021-11-12
4
C
0
4300000
A
4300000
D
Class A Common Stock
2021-11-12
4
J
0
4300000
0.00
D
0
D
Class A Common Stock
2021-11-12
4
J
0
1089179
0.00
A
1089179
I
By: InterWest Management Partners X, LLC
Class A Common Stock
2021-11-12
4
J
0
1089179
0.00
D
0
I
By: InterWest Management Partners X, LLC
Class A Common Stock
2021-11-12
4
J
0
40626
0.00
A
40626
I
By: Khaled A. Nasr
Class A Common Stock
2021-11-12
4
J
0
27229
0.00
A
27229
I
By: Keval Desai
Class B Common Stock
2021-11-12
4
C
0
4300000
0.00
D
Class A Common Stock
4300000
12856998
D
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.
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.
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.
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.
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.
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.
/s/ Karen A. Wilson, Attorney-in Fact for InterWest Partners X, LP
2021-11-15
/s/ Karen A. Wilson, Attorney-in Fact for InterWest Management Partners X, LLC
2021-11-15
/s/ Karen A. Wilson, Attorney-in Fact for Khlaed A. Nasr
2021-11-15
/s/ Karen A. Wilson, Attorney-in Fact for Keval Desai
2021-11-15