0001562180-22-006196.txt : 20220817 0001562180-22-006196.hdr.sgml : 20220817 20220817183357 ACCESSION NUMBER: 0001562180-22-006196 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220816 FILED AS OF DATE: 20220817 DATE AS OF CHANGE: 20220817 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DUNN JEFFREY W CENTRAL INDEX KEY: 0001035986 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38701 FILM NUMBER: 221175759 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 2022-08-16 false 0001459839 SI-BONE, Inc. SIBN 0001035986 DUNN JEFFREY W C/O SI-BONE, INC. 471 EL CAMINO REAL, SUITE 101 SANTA CLARA CA 95050 true false false false Common Stock 2022-08-16 4 S false 4495.00 17.2872 D 130772.00 D Common Stock 2022-08-16 4 S false 1956.00 17.2872 D 128816.00 D Common Stock 2022-08-16 4 S false 1514.00 17.2872 D 124027.00 D Common Stock 101460.00 I by Trust 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 115,956 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. Reflects the transfer of shares from the Reporting Person to The Jeffrey W. Dunn Living Trust Dated May 17, 2012. Shares held by The Jeffrey W. Dunn Living Trust Dated May 17, 2012 /s/ Michael A. Pisetsky, Attorney-in-Fact for Jeffrey W. Dunn 2022-08-18