0001562180-23-007214.txt : 20231004
0001562180-23-007214.hdr.sgml : 20231004
20231004175319
ACCESSION NUMBER: 0001562180-23-007214
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20231002
FILED AS OF DATE: 20231004
DATE AS OF CHANGE: 20231004
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: 231309133
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
2023-10-02
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
true
Common Stock
2023-10-02
4
M
false
20000.00
4.32
A
89645.00
D
Common Stock
2023-10-02
4
S
false
20000.00
21.1869
D
69645.00
D
Common Stock
132580.00
I
by Trust
Stock Option (Right to Buy)
4.32
2023-10-02
4
M
false
20000.00
0.00
D
2026-07-26
Common Stock
20000.00
81241.00
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 $20.96 to $21.51, inclusive. 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 53,089 shares issuable on the settlement of restricted stock units granted to the Reporting Person. Each restricted stock unit
represents 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 the 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
2023-10-04