SEC Form 4
FORM 4 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol Doximity, Inc. [ DOCS ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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3. Date of Earliest Transaction (Month/Day/Year) 06/28/2021 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed (Month/Day/Year) | 6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series C Preferred Stock | (1) | 06/28/2021 | C | 4,667,276 | (1) | (1) | Class B Common Stock(2) | 4,667,276 | $0 | 0 | D(3) | ||||
Series C Preferred Stock | (1) | 06/28/2021 | C | 518,586 | (1) | (1) | Class B Common Stock(2) | 518,586 | $0 | 0 | I(4) | By Threshold Ventures I Partners Fund, LLC(4) | |||
Class B Common Stock | (2) | 06/28/2021 | C(1) | 4,667,276 | (2) | (2) | Class A Common Stock | 4,667,276 | $0 | 4,667,276 | D(3) | ||||
Class B Common Stock | (2) | 06/28/2021 | C(1) | 518,586 | (2) | (2) | Class A Common Stock | 518,586 | $0 | 518,586 | I(4) | By Threshold Ventures I Partners Fund, LLC(4) |
1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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1. Name and Address of Reporting Person*
(Street)
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Explanation of Responses: |
1. Each share of Series C Preferred Stock automatically converted 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 Series C 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 Threshold Ventures I, L.P. ("Threshold I"). Threshold Ventures I General Partner, LLC ("Threshold I GP") is the general partner of Threshold I and may be deemed to have sole voting, investment and dispositive power over the shares held by Threshold I. Threshold I GP may be deemed to have sole voting, investment and dispositive power over the shares held by Threshold I GP. Josh Stein and Andreas Stavropoulos, the managing members of Threshold I GP, may be deemed to have shared voting, investment and dispositive power over such shares. Such individuals and entities disclaim beneficial ownership of such shares except to the extent of their pecuniary interest therein. |
4. These shares are directly held by Threshold Ventures I Partners Fund, LLC ("Threshold I Partners"). Josh Stein and Andreas Stavropoulos, the voting members of Threshold I Partners, may be deemed to have shared voting, investment and dispositive power over the shares held by Threshold I Partners. Such individuals disclaim beneficial ownership of such shares except to the extent of their pecuniary interest therein. |
Remarks: |
THRESHOLD VENTURES I, L.P. By: Threshold Ventures I General Partner, LLC, its General Partner By: /s/ Josh Stein, Managing Member | 06/28/2021 | |
THRESHOLD VENTURES I PARTNERS FUND, LLC By: /s/ Josh Stein, Managing Member | 06/28/2021 | |
THRESHOLD VENTURES I GENERAL PARTNER, LLC By: /s/ Josh Stein, Managing Member | 06/28/2021 | |
JOSH STEIN /s/ Josh Stein | 06/28/2021 | |
** 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 4 (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). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |