0001562180-21-004255.txt : 20210614 0001562180-21-004255.hdr.sgml : 20210614 20210614174104 ACCESSION NUMBER: 0001562180-21-004255 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: HINCKLEY GREGORY K CENTRAL INDEX KEY: 0001239182 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38701 FILM NUMBER: 211015775 MAIL ADDRESS: STREET 1: C/OMENTOR GRAPHICS CORP STREET 2: 8005 SW BOECKMAN ROAD CITY: WILSONVILLE STATE: OR ZIP: 97070-7777 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 0001239182 HINCKLEY GREGORY K 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 66403.00 D Common Stock 75603.00 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 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 Gregory K. Hinckley and Mary C. Hinckley as Community Property with the Right of Survivorship /s/ Michael A. Pisetsky, Attorney-in-Fact for Gregory K. Hinckley 2021-06-14