0001562180-22-004167.txt : 20220517 0001562180-22-004167.hdr.sgml : 20220517 20220517205511 ACCESSION NUMBER: 0001562180-22-004167 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220516 FILED AS OF DATE: 20220517 DATE AS OF CHANGE: 20220517 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: 22936767 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 2022-05-16 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 2022-05-16 4 S false 878.00 12.5807 D 125178.00 D Common Stock 2022-05-16 4 S false 1419.00 12.5807 D 123759.00 D Common Stock 2022-05-16 4 S false 128.00 12.5807 D 123631.00 D Common Stock 2022-05-16 4 S false 50.00 12.5807 D 123581.00 D Common Stock 2022-05-16 4 S false 991.00 12.5807 D 123724.00 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 81,706 shares issuable on 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. Includes 1,134 shares acquired under the SI-BONE, Inc. 2018 Employee Stock Purchase Plan on May 15, 2022. /s/ Michael A. Pisetsky 2022-05-18