0001209191-19-004390.txt : 20190117 0001209191-19-004390.hdr.sgml : 20190117 20190117184417 ACCESSION NUMBER: 0001209191-19-004390 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190115 FILED AS OF DATE: 20190117 DATE AS OF CHANGE: 20190117 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: RECUPERO ANTHONY J CENTRAL INDEX KEY: 0001210230 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38701 FILM NUMBER: 19531809 MAIL ADDRESS: STREET 1: C/O SI-BONE, INC. STREET 2: 471 EL CAMINO REAL, SUITE 101 CITY: SANTA CLARA STATE: CA ZIP: 95050 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 doc4.xml FORM 4 SUBMISSION X0306 4 2019-01-15 0 0001459839 SI-BONE, Inc. SIBN 0001210230 RECUPERO ANTHONY J C/O SI-BONE, INC. 471 EL CAMINO REAL, SUITE 101 SANTA CLARA CA 95050 0 1 0 0 Chief Commercial Officer Common Stock 2019-01-15 4 A 0 19700 0.00 A 19700 D Stock Option (right to buy) 22.00 2019-01-15 4 A 0 42700 0.00 A 2029-01-15 Common Stock 42700 42700 D Reflects shares issuable on settlement of restricted stock units granted to the Reporting Person. Each restricted stock unit represents a contingent right to receive one shares of the Issuer's common stock. The shares subject to the restricted stock unit vest in equal quarterly installments over four years commencing on January 15, 2019, subject to the Reporting Person's continued service through each relevant vesting date. The shares subject to the option vest in equal monthly installments over four years commencing on January 15, 2019, subject to Reporting Person's continued service through each relevant vesting date. /s/ Michael A. Pisetsky, Attorney-in-Fact for Anthony J. Recupero 2019-01-17