0001562180-20-005448.txt : 20200814 0001562180-20-005448.hdr.sgml : 20200814 20200814182713 ACCESSION NUMBER: 0001562180-20-005448 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200127 FILED AS OF DATE: 20200814 DATE AS OF CHANGE: 20200814 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: 201107153 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Freund John Gordon CENTRAL INDEX KEY: 0001296771 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38701 FILM NUMBER: 201107154 MAIL ADDRESS: STREET 1: 125 UNIVERSITY AVE. STREET 2: C/O SKYLINE VENTURES CITY: PALO ALTO STATE: CA ZIP: 94301 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: 201107155 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 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 2020-01-27 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 0001296771 Freund John Gordon C/O SKYLINE VENTURES 525 UNIVERSITY AVENUE, SUITE 1350 PALO ALTO CA 94301 true false true false 0001434887 Skyline Venture Management V, LLC 525 UNIVERSITY AVENUE, SUITE 1350 PALO ALTO CA 94301 false false true false Common Stock 2020-01-27 4 S false 1000000.00 21.50 D 2819985.00 I By Skyline Venture Partners V, LP Shares are sold in the conjunction with SI-BONE, INC's public offering of common stock announced on January 21st, 2020. 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, is a managing director of LLC and 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. Although each of SVP V and LLC have ceased to be subject to the reporting requirements of Section 16 as a result of this sale of shares and the public offering, Dr. Freund is a director of SI-BONE, Inc. and, accordingly, remains subject to the reporting requirements of Section 16. Skyline Venture Partners V, L.P., By: Skyline Venture Management V, LLC, Its: General Partner, By: /s/ Michael A. Pisetsky , Attorney-in-Fact 2020-08-14 /s/ Michael A. Pisetsky, Attorney-in-Fact for John G. Freund 2020-08-14 Skyline Venture Management V, LLC, By: /s/ Michael A. Pisetsky, Attorney-in-Fact 2020-08-14