0001562180-19-006155.txt : 20191217
0001562180-19-006155.hdr.sgml : 20191217
20191217161023
ACCESSION NUMBER: 0001562180-19-006155
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20191213
FILED AS OF DATE: 20191217
DATE AS OF CHANGE: 20191217
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Pisetsky Michael A
CENTRAL INDEX KEY: 0001754765
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38701
FILM NUMBER: 191289832
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
primarydocument.xml
PRIMARY DOCUMENT
X0306
4
2019-12-13
false
0001459839
SI-BONE, Inc.
SIBN
0001754765
Pisetsky Michael A
C/O SI-BONE, INC.
471 EL CAMINO REAL, SUITE 101
SANTA CLARA
CA
95050
false
true
false
false
GC & Chief Compliance Officer
Common Stock
2019-12-13
4
M
false
3000.00
4.32
A
20583.00
D
Common Stock
2019-12-13
4
S
false
3000.00
20.00
D
17583.00
D
Stock Option (Right to Buy)
4.32
2019-12-13
4
M
false
3000.00
0.00
D
2026-07-26
Common Stock
3000.00
29038.00
D
The sale reported on this Form 4 was effected pursuant to a 10b5-1 trading plan.
Includes 9,262 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 option vest in equal monthly installments over four years commencing on vesting commencement date, subject to Reporting Person's continued service through each relevant vesting date.
/s/ Michael A. Pisetsky
2019-12-17