Tangney Jeffrey - 10 Nov 2021 Form 4/A - Amendment Insider Report for Doximity, Inc. (DOCS)

Role: Chief Executive Officer, Director, 10%+ Owner
Signature: /s/ Jennifer Chaloemtiarana, Attorney-in-Fact for Jeffrey Tangney
Issuer symbol: DOCS
Transactions as of: 10 Nov 2021
Net transactions value: $0
Form type: 4/A - Amendment
Filing time: 30 Nov 2023, 17:04:11 UTC
Date Of Original Report: 19 Nov 2021
Previous filing: 23 Jun 2021
Next filing: 08 Dec 2021
SEC: View on sec.gov

Transactions Table

Type	Sym	Class	Transaction	Value $	Shares	Change %	* Price $	Shares After	Date	Ownership	Footnotes
transaction	DOCS	Class A Common Stock	Conversion of derivative security		+100,000			100,000	10 Nov 2021	Direct	F1, F2, F3
transaction	DOCS	Class A Common Stock	Conversion of derivative security		+260,000			260,000	10 Nov 2021	By Tangney Schweikert Family Trust	F1, F2, F4
transaction	DOCS	Class A Common Stock	Gift	$0	-150,000	-58%	$0.000000	110,000	10 Nov 2021	By Tangney Schweikert Family Trust	F1, F4, F5
transaction	DOCS	Class A Common Stock	Gift	$0	+150,000	+150%	$0.000000	250,000	10 Nov 2021	Direct	F1, F3, F5
transaction	DOCS	Class A Common Stock	Gift	$0	-110,000	-100%	$0.000000^*	0	17 Nov 2021	By Tangney Schweikert Family Trust	F4, F6

Derivative Securities (e.g., puts, calls, warrants, options, convertible securities)

Type	Sym	Class	Transaction	Value $	Shares	Change %	* Price $	Shares After	Date	Underlying Class	Amount	Exercise Price	Ownership	Footnotes
transaction	DOCS	Class B Common Stock	Conversion of derivative security	$0	-100,000	-1.6%	$0.000000	6,321,666	10 Nov 2021	Class A Common Stock	100,000		Direct	F1, F2, F3, F7
transaction	DOCS	Class B Common Stock	Conversion of derivative security	$0	-260,000	-1.1%	$0.000000	24,203,330	10 Nov 2021	Class A Common Stock	260,000		By Tangney Schweikert Family Trust	F1, F2, F4, F7
holding	DOCS	Class B Common Stock						20,000,000	10 Nov 2021	Class A Common Stock	20,000,000		By Tangney Annuity Trust, LLC	F7, F8

* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id	Content
F1	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.
F2	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.
F3	These shares are owned directly by Jeffrey Tangney.
F4	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.
F5	On November 10, 2021, the Tangney Schweikert Family Trust transferred 150,000 shares of Class A Common Stock to Mr. Tangney for no consideration.
F6	Represents a bona fide gift of shares of Class A Common Stock to a charitable donor advised fund.
F7	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.
F8	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.