0001562180-21-004403.txt : 20210621 0001562180-21-004403.hdr.sgml : 20210621 20210621175154 ACCESSION NUMBER: 0001562180-21-004403 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210617 FILED AS OF DATE: 20210621 DATE AS OF CHANGE: 20210621 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: 211032233 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 2021-06-17 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 2021-06-17 4 M false 3200.00 4.32 A 187964.00 D Common Stock 2021-06-17 4 S false 3200.00 32.0864 D 184764.00 D Common Stock 56128.00 I by Trust Stock Option (Right to Buy) 4.32 2021-06-17 4 M false 3200.00 0.00 D 2025-05-25 Common Stock 3200.00 39667.00 D The sale reported on this Form 4 was effected pursuant to a 10b5-1 trading plan. The price reported in column 4 is a weighted-average price. The shares were sold in multiple transactions ranging from $32.00 to $32.19, inclusive. The Reporting Person undertakes to provide the Issuer, any securityholder 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 these footnotes. Represents shares issuable on the settlement of the net restricted stock units granted and canceled to the Reporting Person. Each restricted stock unit represents a contingent right to receive one share of the Issuer's common stock. Shares held by The Jeffrey W. Dunn Living Trust Dated May 17, 2012. The shares subject to the option vest in equal monthly installments over four years commencing on vesting commencement date, subject to Reporting Person's continued service through each relevant vesting date. /s/ Michael A. Pisetsky, Attorney-in-Fact for Jeffrey W. Dunn 2021-06-21