0001562180-21-004257.txt : 20210614
0001562180-21-004257.hdr.sgml : 20210614
20210614174131
ACCESSION NUMBER: 0001562180-21-004257
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: Freund John Gordon
CENTRAL INDEX KEY: 0001296771
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38701
FILM NUMBER: 211015780
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
2021-06-10
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
2021-06-10
4
A
false
3848.00
0.00
A
12645.00
D
Common Stock
100750.00
I
By John Freund Family Partnership IV, L.P
Common Stock
383458.00
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 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 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.
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.
/s/ Michael A. Pisetsky, Attorney-in-Fact for John G. Freund
2021-06-14