0001562180-21-004254.txt : 20210614
0001562180-21-004254.hdr.sgml : 20210614
20210614174100
ACCESSION NUMBER: 0001562180-21-004254
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210610
FILED AS OF DATE: 20210614
DATE AS OF CHANGE: 20210614
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: HILLEMAN JERYL L
CENTRAL INDEX KEY: 0001216628
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38701
FILM NUMBER: 211015774
MAIL ADDRESS:
STREET 1: C/O INTERSECT ENT, INC.
STREET 2: 1555 ADAMS DRIVE
CITY: MENLO PARK
STATE: CA
ZIP: 94025
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
2021-06-10
false
0001459839
SI-BONE, Inc.
SIBN
0001216628
HILLEMAN JERYL L
C/O SI-BONE, INC.
471 EL CAMINO REAL, SUITE 101
SANTA CLARA
CA
95050
true
false
false
false
Common Stock
2021-06-10
4
A
false
3848.00
0.00
A
12645.00
D
Reflects 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. The shares subject to the restricted stock unit will be vesting 100% upon
the earlier of (i) the next annual general meeting of the stockholders of the Company or (ii) the date one year from the Vesting Commencement Date, subject to the Reporting Person's continuous service as a member of the Company's Board of Directors until such
date.
Includes 3,848 shares issuable on 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.
/s /Michael Pisetsky, Attorney-in-Fact for Jeryl L Hilleman
2021-06-14