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