0001562180-20-004584.txt : 20200618
0001562180-20-004584.hdr.sgml : 20200618
20200618182352
ACCESSION NUMBER: 0001562180-20-004584
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20200616
FILED AS OF DATE: 20200618
DATE AS OF CHANGE: 20200618
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Freund John Gordon
CENTRAL INDEX KEY: 0001296771
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38701
FILM NUMBER: 20973786
MAIL ADDRESS:
STREET 1: 125 UNIVERSITY AVE.
STREET 2: C/O SKYLINE VENTURES
CITY: PALO ALTO
STATE: CA
ZIP: 94301
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
2020-06-16
false
0001459839
SI-BONE, Inc.
SIBN
0001296771
Freund John Gordon
C/O SKYLINE VENTURES
525 UNIVERSITY AVENUE, SUITE 1350
PALO ALTO
CA
94301
true
false
true
false
Common Stock
2020-06-16
4
A
false
8797.00
0.00
A
8797.00
D
Common Stock
2819985.00
I
Skyline Venture Partners V, L.P.
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 8,797 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 Skyline Venture Partners V L.P. ("SVP V"). Skyline Venture Management V, LLC ("LLC") is the general partner of SVP V. Dr. Freund, a member of the Issuer's board of directors, is managing director of LLC and as such may be deemed to have voting and investment power with respect to the securities of SVP V. Dr. Freund disclaim beneficial ownership of such securities, except to the extent of their pecuniary interest therein.
/s/ Michael A. Pisetsky, Attorney-in-Fact for John G. Freund
2020-06-18