0001562180-19-004290.txt : 20190814
0001562180-19-004290.hdr.sgml : 20190814
20190814202411
ACCESSION NUMBER: 0001562180-19-004290
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20190812
FILED AS OF DATE: 20190814
DATE AS OF CHANGE: 20190814
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Skyline Venture Partners V LP
CENTRAL INDEX KEY: 0001419187
STATE OF INCORPORATION: DE
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38701
FILM NUMBER: 191028208
BUSINESS ADDRESS:
STREET 1: 525 University Avenue
STREET 2: Suite 520
CITY: Palo Alto
STATE: CA
ZIP: 94301
MAIL ADDRESS:
STREET 1: 525 University Avenue
STREET 2: Suite 520
CITY: Palo Alto
STATE: CA
ZIP: 94301
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Skyline Venture Management V, LLC
CENTRAL INDEX KEY: 0001434887
STATE OF INCORPORATION: CA
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38701
FILM NUMBER: 191028209
BUSINESS ADDRESS:
STREET 1: 525 UNIVERSITY AVENUE
CITY: PALO ALTO
STATE: CA
ZIP: 94301
BUSINESS PHONE: 650-475-0144
MAIL ADDRESS:
STREET 1: 525 UNIVERSITY AVENUE
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
2019-08-12
false
0001459839
SI-BONE, Inc.
SIBN
0001419187
Skyline Venture Partners V LP
525 UNIVERSITY AVENUE, SUITE 1350
PALO ALTO
CA
94301
false
false
true
false
0001434887
Skyline Venture Management V, LLC
525 UNIVERSITY AVENUE, SUITE 1350
PALO ALTO
CA
94301
false
false
true
false
Common Stock
2019-08-12
4
S
false
400000.00
18.25
D
4019985.00
I
By Skyline Venture Partners V, L.P
Shares held by Skyline Venture Partners V, L.P. ("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. Dr. Freund, a member of the Issuer's board of directors, together with Yasunori Kaneko, are the managing directors of LLC and each may be deemed to have voting and investment power with respect to the securities held by SVP V. Dr. Freund disclaims beneficial ownership of such securities, except to the extent of his pecuniary interest therein.
Skyline Venture Partners V, L.P., By: Skyline Venture Management V, LLC, Its: General Partner, By: /s/ Michael A. Pisetsky , Attorney-in-Fact
2019-08-14
Skyline Venture Management V, LLC, By: /s/ Michael A. Pisetsky, Attorney-in-Fact
2019-08-14
EX-24
2
poaskylineventure.txt
POWER OF ATTORNEY
POWER OF ATTORNEY
Know all by these presents, that the undersigned hereby constitutes and
appoints each of LAURA A. FRANCIS, MICHAEL A. PISETSKY,
MATTHEW B. HEMINGTON and JOHN T. MCKENNA, signin
individually, the undersigned's true and lawful attorneys-in fact
and agents to:
(1) execute for and on behalf of the undersigned,
in the undersigned's capacity as an officer, director
or beneficial owner of more than 10% of a registered
class of securities of SI-BONE, INC. (the "Company"),
Forms 3, 4 and 5 (including any amendments thereto)
in accordance with Section 16(a) of the Securities
Exchange Act of 1934, as amended (the "Exchange Act")
and the rules thereunder and a Form ID, Uniform Application
for Access Codes to File on EDGAR;
(2) do and perform any and all acts for and on behalf of
the undersigned that may be necessary or desirable to execute
such Forms 3, 4 or 5 or Form ID (including any amendments thereto)
and timely file such forms with the United States Securities and
Exchange Commission and any stock exchange or similar authority;
and
(3) take any other action of any nature whatsoever in connection
with the foregoing which, in the opinion of such attorney-in-fact,
may be of benefit, in the best interest of, or legally required by,
the undersigned, it being understood that the documents executed by
such attorney-in-fact on behalf of the undersigned pursuant to this
Power of Attorney shall be in such form and shall contain such terms
and conditions as such attorney-in-fact may approve in such
attorney-in-fact's discretion.
The undersigned hereby grants to each such attorney-in-fact full
power and authority to do and perform any and every act and thing
whatsoever requisite, necessary or proper to be done in the
exercise of any of the rights and powers herein granted,
as fully to all intents and purposes as the undersigned might
or could do if personally present, with full power of
substitution or revocation, hereby ratifying and confirming
all that such attorney-in-fact, or such attorney-in-fact's
substitute or substitutes, shall lawfully do or cause to be
done by virtue of this power of attorney and the rights and
powers herein granted. The undersigned acknowledges that the
foregoing attorneys-in-fact, in serving in such capacity at
the request of the undersigned, are not assuming, nor is the
Company assuming, any of the undersigned's responsibilities to
comply with Section 16 of the Exchange Act.
This Power of Attorney shall remain in full force and effect
until the earliest to occur of (a) the undersigned is no longer
required to file Forms 3, 4 and 5 with respect to the
undersigned's holdings of and transactions in securities issued
by the Company, (b) revocation by the undersigned in a signed
writing delivered to the foregoing attorneys-in-fact or (c)
as to any attorney-in-fact individually, until such
attorney-in-fact is no longer employed by the Company
or Cooley LLP.
IN WITNESS WHEREOF, the undersigned has caused this
Power of Attorney to be executed as of August 13, 2019.
SKYLINE VENTURE PARTNERS V, L.P.
By: Skyline Venture Management V, LLC
Its: General Partner
By: /s/John G. Freund-Managing Director
SKYLINE VENTURE MANAGEMENT V, LLC
By:/s/John G. Freund-Managing Member