0001562180-20-004583.txt : 20200618 0001562180-20-004583.hdr.sgml : 20200618 20200618182344 ACCESSION NUMBER: 0001562180-20-004583 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200616 FILED AS OF DATE: 20200618 DATE AS OF CHANGE: 20200618 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Davis Timothy E JR CENTRAL INDEX KEY: 0001492082 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38701 FILM NUMBER: 20973785 MAIL ADDRESS: STREET 1: 5677 AIRLINE ROAD CITY: ARLINGTON STATE: TN ZIP: 38002 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 2020-06-16 false 0001459839 SI-BONE, Inc. SIBN 0001492082 Davis Timothy E JR C/O SI-BONE, INC. 471 EL CAMINO REAL, SUITE 101 SANTA CLARA CA 95050 true false false false Common Stock 2020-06-16 4 A false 8797.00 0.00 A 15223.00 D 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 8,797 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, Attorney-in-Fact for Timothy E. Davis, Jr. 2020-06-18