0001516513-23-000091.txt : 20231130
0001516513-23-000091.hdr.sgml : 20231130
20231130170411
ACCESSION NUMBER: 0001516513-23-000091
CONFORMED SUBMISSION TYPE: 4/A
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211110
FILED AS OF DATE: 20231130
DATE AS OF CHANGE: 20231130
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Tangney Jeffrey
CENTRAL INDEX KEY: 0001863328
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40508
FILM NUMBER: 231456523
MAIL ADDRESS:
STREET 1: C/O DOXIMITY, INC.
STREET 2: 500 3RD STREET SUITE 510
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94107
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Tangney Schweikert Family Trust
CENTRAL INDEX KEY: 0001868242
STATE OF INCORPORATION: CA
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40508
FILM NUMBER: 231456522
BUSINESS ADDRESS:
STREET 1: C/O DOXIMITY, INC.
STREET 2: 500 3RD STREET, SUITE 510
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94107
BUSINESS PHONE: 650-549-4330
MAIL ADDRESS:
STREET 1: C/O DOXIMITY, INC.
STREET 2: 500 3RD STREET, SUITE 510
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94107
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Tangney Annuity Trust, LLC
CENTRAL INDEX KEY: 0001867907
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40508
FILM NUMBER: 231456521
BUSINESS ADDRESS:
STREET 1: C/O DOXIMITY, INC.
STREET 2: 500 3RD STREET, SUITE 510
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94107
BUSINESS PHONE: 650-549-4330
MAIL ADDRESS:
STREET 1: C/O DOXIMITY, INC.
STREET 2: 500 3RD STREET, SUITE 510
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94107
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/A
1
wk-form4a_1701381839.xml
FORM 4/A
X0508
4/A
2021-11-10
2021-11-19
0
0001516513
Doximity, Inc.
DOCS
0001863328
Tangney Jeffrey
DOXIMITY, INC.
500 THIRD STREET
SAN FRANCISCO
CA
94107
1
1
1
0
Chief Executive Officer
0001868242
Tangney Schweikert Family Trust
C/O DOXIMITY, INC.
500 THIRD STREET
SAN FRANCISCO
CA
94107
0
0
1
0
0001867907
Tangney Annuity Trust, LLC
C/O DOXIMITY, INC.
500 THIRD STREET
SAN FRANCISCO
CA
94107
0
0
1
0
0
Class A Common Stock
2021-11-10
4
C
0
100000
A
100000
D
Class A Common Stock
2021-11-10
4
C
0
260000
A
260000
I
By Tangney Schweikert Family Trust
Class A Common Stock
2021-11-10
5
G
0
E
150000
0
D
110000
I
By Tangney Schweikert Family Trust
Class A Common Stock
2021-11-10
5
G
0
E
150000
0
A
250000
D
Class A Common Stock
2021-11-17
5
G
0
E
110000
0
D
0
I
By Tangney Schweikert Family Trust
Class B Common Stock
2021-11-10
4
C
0
100000
0
D
Class A Common Stock
100000
6321666
D
Class B Common Stock
2021-11-10
4
C
0
260000
0
D
Class A Common Stock
260000
24203330
I
By Tangney Schweikert Family Trust
Class B Common Stock
Class A Common Stock
20000000
20000000
I
By Tangney Annuity Trust, LLC
This Form 4/A amends and restates the original Form 4, filed on November 19, 2021, as amended by the Forms 4/A filed on November 19, 2021 and December 8, 2021 (collectively, the "Prior Forms"). This Form 4/A is being filed to (i) correctly report certain transaction dates as November 10, 2021, which were incorrectly reported in the Prior Forms and (ii) include certain transactions, which were inadvertently omitted from one or more of the Prior Forms.
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 owned directly by Jeffrey Tangney.
These shares are owned directly by the Tangney Schweikert Family Trust, a ten percent owner of the Issuer and of which Mr. Tangney is trustee. Mr. Tangney disclaims beneficial ownership over the shares held by the Tangney Schweikert Family Trust, except to the extent, if any, of his pecuniary interest therein, and nothing in this report shall be deemed an admission that Mr. Tangney has beneficial ownership over any such shares for Section 16 purposes or otherwise.
On November 10, 2021, the Tangney Schweikert Family Trust transferred 150,000 shares of Class A Common Stock to Mr. Tangney for no consideration.
Represents a bona fide gift of shares of Class A Common Stock to a charitable donor advised fund.
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.
These shares are owned directly by Tangney Annuity Trust, LLC, a ten percent owner of the Issuer and of which Mr. Tangney is trustee. Mr. Tangney disclaims beneficial ownership over the shares held by Tangney Annuity Trust, LLC, except to the extent, if any, of his pecuniary interest therein, and nothing in this report shall be deemed an admission that Mr. Tangney has beneficial ownership over any such shares for Section 16 purposes or otherwise.
/s/ Jennifer Chaloemtiarana, Attorney-in-Fact for Jeffrey Tangney
2023-11-30
/s/ Jennifer Chaloemtiarana, Attorney-in-Fact for Tangney Schweikert Family Trust
2023-11-30
/s/ Jennifer Chaloemtiarana, Attorney-in-Fact for Tangney Annuity Trust, LLC
2023-11-30