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
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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
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4
M
false
3472.00
0.00
D
2026-02-22
Common Stock
3472.00
0.00
D
Stock Option (Right to Buy)
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2022-01-25
4
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4239.00
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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