0001562180-22-005230.txt : 20220621
0001562180-22-005230.hdr.sgml : 20220621
20220621160137
ACCESSION NUMBER: 0001562180-22-005230
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220616
FILED AS OF DATE: 20220621
DATE AS OF CHANGE: 20220621
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Davis Timothy E JR
CENTRAL INDEX KEY: 0001492082
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38701
FILM NUMBER: 221028074
MAIL ADDRESS:
STREET 1: 5677 AIRLINE ROAD
CITY: ARLINGTON
STATE: TN
ZIP: 38002
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
2022-06-16
false
0001459839
SI-BONE, Inc.
SIBN
0001492082
Davis Timothy E JR
C/O SI-BONE, INC.
471 EL CAMINO REAL, SUITE 101
SANTA CLARA
CA
95050
true
false
false
false
Common Stock
2022-06-16
4
A
false
8324.00
0.00
A
27395.00
D
Reflects 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 restricted stock unit will vest 100% upon the earlier of (i) the next annual general meeting of the stockholders of the Company or (ii) the date one year from the Vesting Commencement Date, subject to the Reporting Person's continuous service as a member of the Company's Board of Directors until such date.
Includes 8,324 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.
/s/ Michael A. Pisetsky, Attorney-in-Fact for Timothy E. Davis, Jr.
2022-06-20