Kliman Gilbert H Form 3 Doximity / Gilbert H Kliman ownership change

SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940

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1. Name and Address of Reporting Person^*

Kliman Gilbert H

(Last) (First) (Middle)

C/O INTERWEST PARTNERS

467 FIRST STREET, SUITE 201

(Street)

LOS ALTOS CA 94022

(City) (State) (Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
06/23/2021

3. Issuer Name and Ticker or Trading Symbol
Doximity, Inc. [ DOCS ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

X	Director	X	10% Owner
	Officer (give title below)		Other (specify below)

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
	Date Exercisable	Expiration Date	Title	Amount or Number of Shares
Series A Preferred Stock	(1)	(1)	Class B Common Stock(2)	13,296,504	0.0	I	By InterWest Partners X, L.P.(3)
Series B Preferred Stock	(1)	(1)	Class B Common Stock(2)	5,412,972	0.0	I	By InterWest Partners X, L.P.(3)
Series C Preferred Stock	(1)	(1)	Class B Common Stock(2)	2,736,772	0.0	I	By InterWest Partners X, L.P.(3)

Explanation of Responses:

1. Each share of Series A Preferred Stock, Series B Preferred Stock and Series C Preferred Stock (collectively, the "Preferred Stock") shall automatically convert into one share of Class B Common Stock, par value $0.001 per share (the "Class B Common Stock"), on a one-for-one basis, immediately prior to the closing of the Issuer's initial public offering ("IPO"). The shares of Preferred Stock have no expiration date.

2. 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.

3. These shares are directly held by InterWest Partners X, L.P. ("InterWest"). InterWest Management Partners X, LLC ("IMP X"), as the general partner of InterWest, may be deemed to beneficially own the shares held by InterWest. The Reporting Person is the Managing Director of IMP X, and as such may be deemed to beneficially own the shares held by InterWest. The Reporting Person disclaims beneficial ownership of such shares, except to the extent of his pecuniary interest therein.

Remarks:

	/s/ Jennifer Chaloemtiarana, Attorney-in-Fact	06/23/2021
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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