0001562180-23-007575.txt : 20231106
0001562180-23-007575.hdr.sgml : 20231106
20231106191210
ACCESSION NUMBER: 0001562180-23-007575
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211021
FILED AS OF DATE: 20231106
DATE AS OF CHANGE: 20231106
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: 231381179
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
X0508
4
2021-10-21
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
false
Common Stock
2021-10-21
4
G
false
65251.00
0.00
D
83885.00
I
By Trust
Common Stock
2023-11-02
4
S
false
406.00
17.5207
D
52683.00
D
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.
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.
This transaction was executed in multiple trades at prices ranging from $17.35 USD to $17.61 USD; the price reported above reflects the weighted average sale price. The Reporting Person undertakes to provide the Issuer, any security holder of the Issuer, or the Staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the range set forth in this footnote.
Includes 52,272 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.
/s/ Michael A. Pisetsky, Attorney-in-Fact for Jeffrey W. Dunn
2023-11-06