0001628280-21-013077.txt : 20210628 0001628280-21-013077.hdr.sgml : 20210628 20210628181833 ACCESSION NUMBER: 0001628280-21-013077 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210628 FILED AS OF DATE: 20210628 DATE AS OF CHANGE: 20210628 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: 211054963 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: 211054966 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: 211054964 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: 211054965 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: 1211 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 wf-form4_162491868260852.xml FORM 4 X0306 4 2021-06-28 0 0001516513 Doximity, Inc. DOCS 0001443898 INTERWEST PARTNERS X LP C/O INTERWEST PARTNERS 467 FIRST STREET, SUITE 201 LOS ALTOS CA 94022 0 0 1 0 0001460207 InterWest Management Partners X, LLC C/O INTERWEST PARTNERS 467 FIRST STREET, SUITE 201 LOS ALTOS CA 94022 0 0 1 0 0001553019 Desai Keval C/O INTERWEST PARTNERS 467 FIRST STREET, SUITE 201 LOS ALTOS CA 94022 0 0 1 0 0001276600 NASR KHALED C/O INTERWEST PARTNERS 467 FIRST STREET, SUITE 201 LOS ALTOS CA 94022 0 0 1 0 Class A Common Stock 2021-06-28 4 C 0 4289250 A 4289250 D Class A Common Stock 2021-06-28 4 S 0 4289250 24.57 D 0 D Series A Preferred Stock 2021-06-28 4 C 0 13296504 0 D Class B Common Stock 13296504.0 0 D Series B Preferred Stock 2021-06-28 4 C 0 5412972 0 D Class B Common Stock 5412972.0 0 D Series C Preferred Stock 2021-06-28 4 C 0 2736772 0 D Class B Common Stock 2736772.0 0 D Class B Common Stock 2021-06-28 4 C 0 21446248 0 A Class A Common Stock 21446248.0 21446248 D Class B Common Stock 2021-06-28 4 C 0 4289250 0 D Class A Common Stock 4289250.0 17156998 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. These shares are directly held by InterWest Partners X, L.P. ("InterWest"). InterWest Management Partners X, LLC ("IMP X") is the general partner of InterWest. Gilbert H. Kliman is the Managing Director of IMP X. Keval Desai and Khaled Nasr are Venture Members of IMP X. Each of IMP X, Gilbert H. Kliman, Keval Desai and Khaled Nasr may be deemed to beneficially own the shares held by InterWest, and each of IMP X, Gilbert H. Kliman, Keval Desai and Khaled Nasr disclaims beneficial ownership of such shares, except to the extent of its or his pecuniary interest therein. These shares were sold by InterWest in connection with the Issuer's initial public offering ("IPO") at a net price per share of $24.57 (after underwriting discounts and commissions). InterWest was a selling stockholder in the IPO. Each share of Series A Preferred Stock, Series B Preferred Stock and Series C Preferred Stock (collectively, the "Preferred Stock") automatically converted into one share of Class B Common Stock on a one-for-one basis, immediately prior to the closing of the IPO. The shares of Preferred Stock have no expiration date. 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 IMP X, 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, L.P. 2021-06-28 /s/ Karen A. Wilson, Attorney-in-Fact for InterWest Management Partners X, LLC 2021-06-28 /s/ Karen A. Wilson, Attorney-in-Fact for Keval Desai 2021-06-28 /s/ Karen A. Wilson, Attorney-in-Fact for Khaled Nasr 2021-06-28