0001562180-21-004320.txt : 20210616
0001562180-21-004320.hdr.sgml : 20210616
20210616174942
ACCESSION NUMBER: 0001562180-21-004320
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210616
FILED AS OF DATE: 20210616
DATE AS OF CHANGE: 20210616
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: 211022593
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
2021-06-16
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
2021-06-16
4
M
false
6170.00
5.94
A
72573.00
D
Common Stock
2021-06-16
4
S
false
1179.00
31.46
D
71394.00
D
Common Stock
75603.00
D
Stock Option (Right to Buy)
5.94
2021-06-16
4
M
false
6170.00
0.00
D
2027-03-01
Common Stock
6170.00
3085.00
D
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
The shares subject to the option vest in equal monthly installments over three 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 Gregory K. Hinckley
2021-06-16