0001562180-24-005023.txt : 20240612
0001562180-24-005023.hdr.sgml : 20240612
20240612203603
ACCESSION NUMBER: 0001562180-24-005023
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20240610
FILED AS OF DATE: 20240612
DATE AS OF CHANGE: 20240612
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: DUNN JEFFREY W
CENTRAL INDEX KEY: 0001035986
ORGANIZATION NAME:
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38701
FILM NUMBER: 241039821
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]
ORGANIZATION NAME: 08 Industrial Applications and Services
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
X0508
4
2024-06-10
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
false
false
false
false
Common Stock
2024-06-10
4
S
false
341.00
12.9918
D
18814.00
D
Common Stock
103029.00
I
by Trust
The sale reported on this Form 4 represents shares required to be sold by the Reporting Person to cover tax withholding obligations in
connection with the vesting of restricted stock units. The sale satisfies the tax withholding obligations to be funded by a "sell to cover" transaction and does not represent a discretionary trade by the Reporting Person.
This transaction was executed in multiple trades at prices ranging from $12.93 USD to $13.07 USD; the price reported above reflects the weighted average sale price. The Reporting Person undertakes to provide the Issuer, any security holder 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 this footnote.
Reflects the transfer of shares from the Reporting Person to The Jeffrey W. Dunn Living Trust Dated May 17, 2012.
Includes 18,344 shares issuable on the settlement of restricted stock units granted 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.
/s/ Michael A. Pisetsky, Attorney-in-Fact for Jeffrey W. Dunn
2024-06-12