0001562180-21-005022.txt : 20210720
0001562180-21-005022.hdr.sgml : 20210720
20210720185035
ACCESSION NUMBER: 0001562180-21-005022
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210716
FILED AS OF DATE: 20210720
DATE AS OF CHANGE: 20210720
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: 211102233
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
2021-07-16
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
SVP, Ops & Adm/Chief Legal Ofr
Common Stock
2021-07-16
4
S
false
354.00
29.1048
D
78682.00
D
The sale reported on this Form 4 represents shares required to be sold by the Reporting Person to cover tax withholding obligations in
connection with the vesting of restricted stock units. The sale satisfies the tax withholding obligations to be funded by a "sell to cover" transaction
and does not represent a discretionary trade by the Reporting Person.
Includes 56,722 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.
/s/ Michael A. Pisetsky
2021-07-20