0001562180-22-000699.txt : 20220127 0001562180-22-000699.hdr.sgml : 20220127 20220127162935 ACCESSION NUMBER: 0001562180-22-000699 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220125 FILED AS OF DATE: 20220127 DATE AS OF CHANGE: 20220127 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: 22563539 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 2022-01-25 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 2022-01-25 4 M false 2180.00 4.32 A 120443.00 D Common Stock 2022-01-25 4 M false 245.00 4.32 A 120688.00 D Common Stock 2022-01-25 4 M false 3472.00 4.32 A 124160.00 D Common Stock 2022-01-25 4 M false 4239.00 4.32 A 128399.00 D Stock Option (Right to Buy) 4.32 2022-01-25 4 M false 2180.00 0.00 D 2025-05-25 Common Stock 2180.00 0.00 D Stock Option (Right to Buy) 4.32 2022-01-25 4 M false 245.00 0.00 D 2025-05-25 Common Stock 245.00 0.00 D Stock Option (Right to Buy) 4.32 2022-01-25 4 M false 3472.00 0.00 D 2026-02-22 Common Stock 3472.00 0.00 D Stock Option (Right to Buy) 4.32 2022-01-25 4 M false 4239.00 0.00 D 2026-07-26 Common Stock 4239.00 8699.00 D Includes 93,582 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 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 2022-01-27