0001562180-24-005336.txt : 20240627
0001562180-24-005336.hdr.sgml : 20240627
20240627175411
ACCESSION NUMBER: 0001562180-24-005336
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20240625
FILED AS OF DATE: 20240627
DATE AS OF CHANGE: 20240627
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: West Thomas A.
CENTRAL INDEX KEY: 0001620705
ORGANIZATION NAME:
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38701
FILM NUMBER: 241080718
MAIL ADDRESS:
STREET 1: C/O INTERSECT, INC.
STREET 2: 1555 ADAMS DRIVE
CITY: MENLO PARK
STATE: CA
ZIP: 94025
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: SI-BONE, Inc.
CENTRAL INDEX KEY: 0001459839
STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
ORGANIZATION NAME: 08 Industrial Applications and Services
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
3
1
primarydocument.xml
PRIMARY DOCUMENT
X0206
3
2024-06-25
1
0001459839
SI-BONE, Inc.
SIBN
0001620705
West Thomas A.
C/O SI-BONE, INC.
471 EL CAMINO REAL, SUITE 101
SANTA CLARA
CA
95050
true
false
false
false
/s /Michael Pisetsky, Attorney-in-Fact for Thomas A. West
2024-06-27
EX-24
2
twestpoa.txt
POA
POWER OF ATTORNEY
Know all by these presents, that the undersigned hereby
constitutes and appoints each of LAURA A. FRANCIS and MICHAEL A.
PISETSKY of SI-BONE, Inc. (the "Company") and MATTHEW B. HEMINGTON,
JOHN T. MCKENNA, KATE NICHOLS and KRIS TAMASHIRO of Cooley LLP, signing
individually, the undersigned's true and lawful attorneys-in-
fact and agents to:
(1) Prepare, execute in the undersigned's name and on
the undersigned's behalf, and submit to the Securities and
Exchange Commission (the "SEC"), a Form ID, Uniform Application
for Access Codes to File on EDGAR, including amendments thereto,
and any other documents necessary or appropriate to obtain codes
and passwords enabling the undersigned to make electronic
filings with the SEC of reports required by Section 16(a) of the
Securities Exchange Act of 1934, as amended (the "Exchange
Act"), or any rule or regulation thereunder;
(2) Prepare, execute in the undersigned's name and on
the undersigned's behalf, and submit to the SEC Forms 3, 4, and
5 (including amendments thereto and joint filing agreements in
connection therewith) in accordance with Section 16(a) of the
Exchange Act and the rules thereunder in the undersigned's
capacity as an officer, director, or beneficial owner of more
than 10% of a registered class of securities of the Company;
(3) Do and perform any and all acts for and on behalf of
the undersigned that may be necessary or desirable to prepare
and execute any such Form 3, 4, or 5 (including amendments
thereto and joint filing agreements in connection therewith) and
file such forms with the SEC and any stock exchange, self-
regulatory association or any similar authority; and
(4) Take any other action of any type whatsoever in
connection with the foregoing that, in the opinion of such
attorney-in-fact, may be of benefit to, in the best interest of,
or legally required of the undersigned, it being understood that
the documents executed by the attorney-in-fact on behalf of the
undersigned pursuant to this Power of Attorney shall be in such
form and shall contain such terms and conditions as the
attorney-in-fact may approve in the attorney-in-fact's
discretion.
The undersigned hereby grants to each such
attorney-in-fact full power and authority to do and perform any
and every act and thing whatsoever requisite, necessary, or
proper to be done in the exercise of any of the rights and
powers herein granted, as fully to all intents and purposes as
the undersigned might or could do if personally present, with
full power of substitution or revocation, hereby ratifying and
confirming all that such attorney-in-fact, or such
attorney-in-fact's substitute or substitutes, shall lawfully do
or cause to be done by virtue of this power of attorney and the
rights and powers herein granted. The undersigned acknowledges
that the foregoing attorneys-in-fact, and their substitutes, in
serving in such capacity at the request of the undersigned, are
not assuming (nor is the Company assuming) any of the
undersigned's responsibilities to comply with Section 16 of the
Exchange Act.
This Power of Attorney shall remain in full force and
effect until the earliest to occur of the following: (a) the
undersigned is no longer required to file Forms 3, 4, and 5 with
respect to the undersigned's holdings of, and transactions in,
securities issued by the Company, (b) revocation by the
undersigned in a signed writing delivered to the Company and the
foregoing attorneys-in fact, or (c) as to any attorney-in-fact
individually, until such attorney-in-fact is no longer employed
by the Company or Cooley LLP, as applicable.
IN WITNESS WHEREOF, the undersigned has caused this Power of
Attorney to be executed as of the date written below.
Thomas A. West Date June 7th, 2024