0001104659-21-138151.txt : 20211112
0001104659-21-138151.hdr.sgml : 20211112
20211112164326
ACCESSION NUMBER: 0001104659-21-138151
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211110
FILED AS OF DATE: 20211112
DATE AS OF CHANGE: 20211112
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: MORGENTHALER VENTURE PARTNERS IX LP
CENTRAL INDEX KEY: 0001439101
STATE OF INCORPORATION: DE
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40508
FILM NUMBER: 211404341
BUSINESS ADDRESS:
STREET 1: 2710 SAND HILL ROAD
STREET 2: SUITE 100
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-388-7600
MAIL ADDRESS:
STREET 1: 2710 SAND HILL ROAD
STREET 2: SUITE 100
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Morgenthaler Management Partners IX, LLC
CENTRAL INDEX KEY: 0001666860
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40508
FILM NUMBER: 211404340
BUSINESS ADDRESS:
STREET 1: 3200 ALPINE ROAD
CITY: PORTOLA VALLEY
STATE: CA
ZIP: 94028
BUSINESS PHONE: 650-388-7600
MAIL ADDRESS:
STREET 1: 3200 ALPINE ROAD
CITY: PORTOLA VALLEY
STATE: CA
ZIP: 94028
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
tm2129009-14_4seq1.xml
OWNERSHIP DOCUMENT
X0306
4
2021-11-10
1
0001516513
Doximity, Inc.
DOCS
0001439101
MORGENTHALER VENTURE PARTNERS IX LP
3200 ALPINE ROAD
PORTOLA VALLEY
CA
94028
0
0
1
0
0001666860
Morgenthaler Management Partners IX, LLC
3200 ALPINE ROAD
PORTOLA VALLEY
CA
94028
0
0
1
0
Class A Common Stock
2021-11-10
4
C
0
17070350
0
A
17070350
D
Class A Common Stock
2021-11-12
4
J
0
8535175
0
D
8535175
D
Class B Common Stock
2021-11-10
4
C
0
17070350
0
D
Class A Common Stock
17070350
0
D
Conversion of a derivative security in accordance of its terms.
These shares are directly held by Morgenthaler Venture Partners IX, L.P. ("Morgenthaler"). Morgenthaler Management Partners IX, LLC ("MMP IX") is the sole general partner of Morgenthaler. MMP IX may be deemed to indirectly beneficially own the shares held by Morgenthaler, and MMP IX disclaims beneficial ownership of such shares, except to the extent of its pecuniary interest therein.
Represents a pro-rata, in-kind distribution by Morgenthaler and its affiliated funds, not for additional consideration, to MMP IX and its respective members and assignees.
Each share of 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 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.
MORGENTHALER VENTURE PARTNERS IX, L.P. By: Morgenthaler Management Partners IX, LLC, its General Partner By: /s/ Travis Boettner, Chef Financial Officer and Chief Compliance Officer
2021-11-12
MORGENTHALER MANAGEMENT PARTNERS IX, LLC By: /s/ Travis Boettner, Chef Financial Officer and Chief Compliance Officer
2021-11-12