4//SEC Filing
NASR KHALED 4
Accession 0000899243-21-044589
CIK 0001516513other
Filed
Nov 14, 7:00 PM ET
Accepted
Nov 15, 4:37 PM ET
Size
22.7 KB
Accession
0000899243-21-044589
Insider Transaction Report
Form 4
Doximity, Inc.DOCS
INTERWEST PARTNERS X LP
10% Owner
Transactions
- Conversion
Class A Common Stock
2021-11-12+4,300,000→ 4,300,000 total - Other
Class A Common Stock
2021-11-12−4,300,000→ 0 total - Other
Class A Common Stock
2021-11-12+27,229→ 27,229 total(indirect: By: Keval Desai) - Other
Class A Common Stock
2021-11-12+1,089,179→ 1,089,179 total(indirect: By LLC) - Other
Class A Common Stock
2021-11-12−1,089,179→ 0 total(indirect: By LLC) - Other
Class A Common Stock
2021-11-12+40,626→ 40,626 total(indirect: By: Khaled A. Nasr) - Conversion
Class B Common Stock
2021-11-12−4,300,000→ 12,856,998 total→ Class A Common Stock (4,300,000 underlying)
NASR KHALED
10% Owner
Transactions
- Other
Class A Common Stock
2021-11-12+40,626→ 40,626 total(indirect: By: Khaled A. Nasr) - Other
Class A Common Stock
2021-11-12+27,229→ 27,229 total(indirect: By: Keval Desai) - Other
Class A Common Stock
2021-11-12+1,089,179→ 1,089,179 total(indirect: By LLC) - Conversion
Class B Common Stock
2021-11-12−4,300,000→ 12,856,998 total→ Class A Common Stock (4,300,000 underlying) - Conversion
Class A Common Stock
2021-11-12+4,300,000→ 4,300,000 total - Other
Class A Common Stock
2021-11-12−4,300,000→ 0 total - Other
Class A Common Stock
2021-11-12−1,089,179→ 0 total(indirect: By LLC)
Desai Keval
10% Owner
Transactions
- Conversion
Class A Common Stock
2021-11-12+4,300,000→ 4,300,000 total - Other
Class A Common Stock
2021-11-12+1,089,179→ 1,089,179 total(indirect: By LLC) - Other
Class A Common Stock
2021-11-12+40,626→ 40,626 total(indirect: By: Khaled A. Nasr) - Other
Class A Common Stock
2021-11-12−4,300,000→ 0 total - Other
Class A Common Stock
2021-11-12−1,089,179→ 0 total(indirect: By LLC) - Other
Class A Common Stock
2021-11-12+27,229→ 27,229 total(indirect: By: Keval Desai) - Conversion
Class B Common Stock
2021-11-12−4,300,000→ 12,856,998 total→ Class A Common Stock (4,300,000 underlying)
InterWest Management Partners X, LLC
10% Owner
Transactions
- Conversion
Class A Common Stock
2021-11-12+4,300,000→ 4,300,000 total - Other
Class A Common Stock
2021-11-12−4,300,000→ 0 total - Other
Class A Common Stock
2021-11-12+1,089,179→ 1,089,179 total(indirect: By LLC) - Other
Class A Common Stock
2021-11-12−1,089,179→ 0 total(indirect: By LLC) - Other
Class A Common Stock
2021-11-12+40,626→ 40,626 total(indirect: By: Khaled A. Nasr) - Other
Class A Common Stock
2021-11-12+27,229→ 27,229 total(indirect: By: Keval Desai) - Conversion
Class B Common Stock
2021-11-12−4,300,000→ 12,856,998 total→ Class A Common Stock (4,300,000 underlying)
Footnotes (5)
- [F1]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.
- [F2]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.
- [F3]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.
- [F4]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.
- [F5]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.
Documents
Issuer
Doximity, Inc.
CIK 0001516513
Entity typeother
Related Parties
1- filerCIK 0001276600
Filing Metadata
- Form type
- 4
- Filed
- Nov 14, 7:00 PM ET
- Accepted
- Nov 15, 4:37 PM ET
- Size
- 22.7 KB