0001516513-21-000032.txt : 20211116
0001516513-21-000032.hdr.sgml : 20211116
20211116171113
ACCESSION NUMBER: 0001516513-21-000032
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211112
FILED AS OF DATE: 20211116
DATE AS OF CHANGE: 20211116
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Benjamin Regina M.
CENTRAL INDEX KEY: 0001594511
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40508
FILM NUMBER: 211417233
MAIL ADDRESS:
STREET 1: 51 SAWYER ROAD, SUITE 200
CITY: WALTHAM
STATE: MA
ZIP: 02453
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
wf-form4_163710065007383.xml
FORM 4
X0306
4
2021-11-12
0
0001516513
Doximity, Inc.
DOCS
0001594511
Benjamin Regina M.
C/O DOXIMITY, INC.
500 THIRD STREET
SAN FRANCISCO
CA
94107
1
0
0
0
Class A Common Stock
2021-11-12
4
C
0
105862
A
105862
D
Class A Common Stock
2021-11-12
4
S
0
82500
74.6687
D
23362
D
Class A Common Stock
2021-11-12
4
S
0
22362
75.7034
D
1000
D
Class A Common Stock
2021-11-12
4
S
0
1000
75.0186
D
0
D
Stock Option (Right to Buy)
2.21
2021-11-12
4
M
0
104862
0
D
2030-09-01
Class B Common Stock
104862.0
431138
D
Stock Option (Right to Buy)
1.05
2021-11-12
4
M
0
1000
0
D
2028-06-05
Class B Common Stock
1000.0
0
D
Class B Common Stock
2021-11-12
4
M
0
104862
0
A
Class A Common Stock
104862.0
104862
D
Class B Common Stock
2021-11-12
4
M
0
1000
0
A
Class A Common Stock
1000.0
105862
D
Class B Common Stock
2021-11-12
4
C
0
105862
0
D
Class A Common Stock
105862.0
0
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.
The price represents the weighted-average price of the shares sold in multiple transactions ranging from $75.0000 to $75.9900 per share, inclusive. The Reporting Person undertakes to provide the Issuer, a security holder of the Issuer, or the Staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the range set forth in this footnote.
The price represents the weighted-average price of the shares sold in multiple transactions ranging from $76.0000 to $76.1800 per share, inclusive. The Reporting Person undertakes to provide the Issuer, a security holder of the Issuer, or the Staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the range set forth in this footnote.
The stock option vests in 36 equal monthly installments after September 2, 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.
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 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.
The stock option was granted on June 6, 2018 and fully vested as of such date.
/s/ Jennifer Chaloemtiarana, Attorney-in-Fact
2021-11-16