0001562180-24-000311.txt : 20240105 0001562180-24-000311.hdr.sgml : 20240105 20240105175225 ACCESSION NUMBER: 0001562180-24-000311 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20240105 FILED AS OF DATE: 20240105 DATE AS OF CHANGE: 20240105 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Maheshwari Anshul CENTRAL INDEX KEY: 0001853089 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38701 FILM NUMBER: 24517717 MAIL ADDRESS: STREET 1: 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] 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 4 1 primarydocument.xml PRIMARY DOCUMENT X0508 4 2024-01-05 false 0001459839 SI-BONE, Inc. SIBN 0001853089 Maheshwari Anshul C/O SI-BONE, INC 471 EL CAMINO REAL, SUITE 101 SANTA CLARA CA 95050 false true false false Chief Financial Officer false Common Stock 2024-01-05 4 A false 51007.00 0.00 A 198275.00 D Common Stock 2024-01-05 4 A false 17002.00 0.00 A 215277.00 D Reflects 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. The shares subject to the restricted stock unit will vest over four years beginning on January 1, 2024, and will be released in quarterly installments, subject to the Reporting Person's continued service through each relevant vesting date. Reflects 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. The shares subject to the restricted stock unit will vest, if at all, over three years based on the Issuer's total shareholder return (TSR) as measured against the TSR of the company at the median of the range TSRs of a set of peer companies established by the Issuer as set forth in the grant. Includes 177,420 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 Pisetsky, Attorney-in-Fact for Anshul Maheshwari 2024-01-05 EX-24 2 anshulmaheshwari2021.txt POA POWER OF ATTORNEY Know all by these presents, that the undersigned hereby constitutes and appoints each of LAURA A. FRANCIS, MICHAEL A. PISETSKY, MATTHEW B. HEMINGTON and KRIS TAMASHIRO, signing individually, the undersigned's true and lawful attorneys-in-fact and agents to: (1) execute for and on behalf of the undersigned, in the undersigned's capacity as an officer, director or beneficial owner of more than 10% of a registered class of securities of SI-BONE, INC. (the "Company"), Forms 3, 4 and 5 (including any amendments thereto) in accordance with Section 16(a) of the Securities Exchange Act of 1934, as amended (the "Exchange Act") and the rules thereunder and a Form ID, Uniform Application for Access Codes to File on EDGAR; (2) do and perform any and all acts for and on behalf of the undersigned that may be necessary or desirable to execute such Forms 3, 4 or 5 or Form ID (including any amendments thereto) and timely file such forms with the United States Securities and Exchange Commission and any stock exchange or similar authority; and (3) take any other action of any nature whatsoever in connection with the foregoing which, in the opinion of such attorney-in-fact, may be of benefit, in the best interest of, or legally required by, the undersigned, it being understood that the documents executed by such 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 such attorney-in-fact may approve in such 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, 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 (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 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. IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of April 19, 2021. /s/ Anshul Maheshwari Anshul Maheshwari