SEC Form 4 · accession 0001209191-18-055699
SI-BONE, Inc. · SIBN
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owners
Daniel K Turner III
10% Owner
Montreux IV Associates, LLC
10% Owner
Montreux Equity Partners IV, L.P.
10% Owner
Montreux Equity Management IV, LLC
10% Owner
Montreux IV Associates IV, LLC
10% Owner
Period of report
Oct 19, 2018
Accepted (ET)
Oct 19, 2018 · 4:49 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001459839
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1,F2 | Oct 19, 2018 | C | 1,102,915 | — | A | 1,102,915 | I | By Montreux Equity Partners IV, L.P. |
| Common StockF3,F2 | Oct 19, 2018 | C | 597,071 | — | A | 1,699,986 | I | By Montreux Equity Partners IV, L.P. |
| Common StockF1,F2 | Oct 19, 2018 | C | 27,409 | — | A | 1,727,395 | I | By Montreux Equity Partners IV, L.P. |
| Common StockF1,F2 | Oct 19, 2018 | C | 78,564 | — | A | 78,564 | I | By Montreux IV Associates, LLC |
| Common StockF3,F2 | Oct 19, 2018 | C | 51,827 | — | A | 130,391 | I | By Montreux IV Associates, LLC |
| Common StockF1,F2 | Oct 19, 2018 | C | 171,929 | — | A | 171,929 | I | By Montreux IV Associates IV, LLC |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Warrant (right to buy)F2,F4 | $9.10 | Oct 19, 2018 | X | 15,496 | D | — | — | Series 5 Preferred Stock | 15,496 | 0 | I |
| Series 5 Preferred StockF2,F1 | $9.10 | Oct 19, 2018 | X | 15,496 | A | — | — | Common Stock | 15,496 | 1,112,312 | I |
| Series 5 Preferred StockF2,F1 | — | Oct 19, 2018 | S | 9,397 | D | — | — | Common Stock | 9,397 | 1,102,915 | I |
| Series 5 Preferred StockF1,F2 | — | Oct 19, 2018 | C | 1,102,915 | D | — | — | Common Stock | 1,102,915 | 0 | I |
| Series 5 Preferred StockF1,F2 | — | Oct 19, 2018 | C | 78,564 | D | — | — | Common Stock | 78,564 | 0 | I |
| Series 6 Preferred StockF3,F2 | — | Oct 19, 2018 | C | 563,926 | D | — | — | Common Stock | 597,071 | 0 | I |
| Series 6 Preferred StockF3,F2 | — | Oct 19, 2018 | C | 48,950 | D | — | — | Common Stock | 51,827 | 0 | I |
| Series 7 Preferred StockF1,F2 | — | Oct 19, 2018 | C | 27,409 | D | — | — | Common Stock | 27,409 | 0 | I |
| Series 7 Preferred StockF1,F2 | — | Oct 19, 2018 | C | 171,929 | D | — | — | Common Stock | 171,929 | 0 | I |
Explanation of responses
- F1The Issuer's Series 5 Preferred Stock and Series 7 Preferred Stock automatically converted into an equal number of shares of Issuer's common stock immediately upon the closing of the Issuer's initial public offering and has no expiration date.
- F2Montreux Equity Management IV, L.L.C. ("MEM IV LLC") is the general partner of each of Montreux Equity Partners IV, L.P., Montreux IV Associates, L.L.C and Montreux IV Associates IV, L.L.C. Daniel K. Turner III is the managing director of MEM IV LLC and may be deemed to have voting and investment power over the shares held by each of these entities. Mr. Turner disclaims beneficial ownership of such shares, except to the extent of his proportionate pecuniary interest, if any.
- F3The Issuer's Series 6 Preferred Stock automatically converted into approximately 1.05878 shares of Issuer's common stock immediately upon the closing of the Issuer's initial public offering and has no expiration date.
- F4Shares subject to the warrant are immediately exercisable. The warrant will expire in connection with the closing of the Issuer's initial public offering.
- F5Immediately prior to the closing of the Issuer's initial public offering, Montreux Equity Partners IV, L.P. exercised a warrant to purchase 15,496 shares of Series 5 Preferred Stock at an exercise price of $9.10 per share. The exercise price was paid on a net exercise cashless basis calculated using the Issuer's initial public offering price of $15.00, resulting in the Issuer withholding 9,397 of the warrant shares to pay the exercise price and issuing MEP the remaining 6,099 shares.