0001562180-21-002250.txt : 20210315
0001562180-21-002250.hdr.sgml : 20210315
20210315183507
ACCESSION NUMBER: 0001562180-21-002250
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210311
FILED AS OF DATE: 20210315
DATE AS OF CHANGE: 20210315
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: 21742957
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
2021-03-11
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
false
false
Common Stock
2021-03-11
4
S
false
63928.00
31.0465
D
1418118.00
I
By Skyline Venture Partners V, LP
Common Stock
2021-03-12
4
S
false
91072.00
31.3912
D
1327046.00
I
By Skyline Venture Partners V, LP
Common Stock
2021-03-15
4
S
false
80887.00
30.9022
D
1246159.00
I
By Skyline Venture Partners V, LP
Common Stock
100570.00
I
By John Freund Family Partnership IV, L.P
Shares held by SVP V. Skyline Venture Management V, LLC ("LLC") is the general partner of SVP V and as such may be deemed to have
voting and investment power with respect to the securities of SVP V. Reporting Person, a member of Issuer's board of directors, is a managing director of LLC and may be deemed to have voting and investment power with respect to the securities held by SVP V. Reporting Person disclaims beneficial ownership of such securities, except to the extent of his pecuniary interest therein.
Shares held by John Freund Family Partnership IV, L.P. ("Family LP"). Reporting Person, a member of Issuer's board of directors, is a general
partner of Family LP and may be deemed to have voting and investment power with respect to the securities held by Family LP. Reporting
Person disclaims beneficial ownership of such securities, except to the extent of his pecuniary interest therein.
/s/ Michael A. Pisetsky, Attorney-in-Fact for John G. Freund
2021-03-15