0001562180-24-000381.txt : 20240109 0001562180-24-000381.hdr.sgml : 20240109 20240109180110 ACCESSION NUMBER: 0001562180-24-000381 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240102 FILED AS OF DATE: 20240109 DATE AS OF CHANGE: 20240109 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Davis Timothy E JR CENTRAL INDEX KEY: 0001492082 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38701 FILM NUMBER: 24524368 MAIL ADDRESS: STREET 1: 5677 AIRLINE ROAD CITY: ARLINGTON STATE: TN ZIP: 38002 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 2024-01-02 false 0001459839 SI-BONE, Inc. SIBN 0001492082 Davis Timothy E JR C/O SI-BONE, INC. 471 EL CAMINO REAL, SUITE 101 SANTA CLARA CA 95050 true false false false true Common Stock 2024-01-02 2024-01-05 4 M false 21111.00 3.24 A 43472.00 D Stock Option (Right to Buy) 3.24 2024-01-02 2024-01-05 4 M false 21111.00 0.00 D 2024-01-16 Common Stock 21111.00 0.00 D The exercise reported on this Form 4 was effected pursuant to a 10b5-1 trading plan adopted by the Reporting Person on August 29th, 2023. Includes 4,866 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 option are fully vested and immediately exercisable. /s/ Michael A. Pisetsky, Attorney-in-Fact for Timothy E. Davis, Jr. 2024-01-09