0001562180-20-002757.txt : 20200330
0001562180-20-002757.hdr.sgml : 20200330
20200330174257
ACCESSION NUMBER: 0001562180-20-002757
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20200326
FILED AS OF DATE: 20200330
DATE AS OF CHANGE: 20200330
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: 20758694
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
2020-03-26
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
2020-03-26
4
A
false
1500.00
0.00
A
51221.00
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 lump sum on January 15, 2021, subject to the Reporting Person's continued service through relevant vesting date.
Includes 42,480 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.
/s/ Michael A. Pisetsky
2020-03-30