0001562180-21-004195.txt : 20210610
0001562180-21-004195.hdr.sgml : 20210610
20210610183000
ACCESSION NUMBER: 0001562180-21-004195
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210608
FILED AS OF DATE: 20210610
DATE AS OF CHANGE: 20210610
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: DUNN JEFFREY W
CENTRAL INDEX KEY: 0001035986
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38701
FILM NUMBER: 211009340
MAIL ADDRESS:
STREET 1: C/O SI-BONE, INC.
STREET 2: 471 EL CAMINO REAL, SUITE 101
CITY: SANTA CLARA
STATE: CA
ZIP: 95050
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: SI-BONE, Inc.
CENTRAL INDEX KEY: 0001459839
STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
IRS NUMBER: 262216351
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 471 EL CAMINO REAL, SUITE 101
CITY: SANTA CLARA
STATE: CA
ZIP: 95050
BUSINESS PHONE: 4082070700
MAIL ADDRESS:
STREET 1: 471 EL CAMINO REAL, SUITE 101
CITY: SANTA CLARA
STATE: CA
ZIP: 95050
FORMER COMPANY:
FORMER CONFORMED NAME: SI-Bone Inc.
DATE OF NAME CHANGE: 20090326
4
1
primarydocument.xml
PRIMARY DOCUMENT
X0306
4
2021-06-08
false
0001459839
SI-BONE, Inc.
SIBN
0001035986
DUNN JEFFREY W
C/O SI-BONE, INC.
471 EL CAMINO REAL, SUITE 101
SANTA CLARA
CA
95050
true
true
false
false
Chairman, President & CEO
Common Stock
2021-06-08
4
M
false
40073.00
4.32
A
224837.00
D
Common Stock
2021-06-08
4
S
false
40073.00
32.0401
D
184764.00
D
Common Stock
2021-06-09
4
M
false
3400.00
4.32
A
188164.00
D
Common Stock
2021-06-09
4
S
false
3400.00
32.00
D
184764.00
D
Common Stock
56128.00
I
by Trust
Stock Option (Right to Buy)
4.32
2021-06-08
4
M
false
40073.00
0.00
D
2025-05-25
Common Stock
40073.00
46267.00
D
Stock Option (Right to Buy)
4.32
2021-06-09
4
M
false
3400.00
0.00
D
2025-05-25
Common Stock
3400.00
42867.00
D
The sale reported on this Form 4 was effected pursuant to a 10b5-1 trading plan.
The price reported in column 4 is a weighted-average price. The shares were sold in multiple transactions ranging from $32.00 to $32.20, inclusive. The Reporting Person undertakes to provide the Issuer, any securityholder of the Issuer, or the Staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the range set forth in these footnotes.
Represents shares issuable on the settlement of the net restricted stock units granted and canceled to the Reporting Person. Each restricted
stock unit represents a contingent right to receive one share of the Issuer's common stock
Shares held by The Jeffrey W. Dunn Living Trust Dated May 17, 2012.
The shares subject to the option vest in equal monthly installments over four years commencing on vesting commencement date, subject to
Reporting Person's continued service through each relevant vesting date.
/s/ Michael A. Pisetsky, Attorney-in-Fact for Jeffrey W. Dunn
2021-06-10