SEC Form 4 · accession 0001209191-18-055700

SI-BONE, Inc. · SIBN

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Director

Period of report

Oct 19, 2018

Accepted (ET)

Oct 19, 2018 · 4:50 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 Stock^F1,F2,F3	Oct 19, 2018	C	605,964	—	A	605,964	I	By OrbiMed Private Investments V, LP
Common Stock^F4,F2,F3	Oct 19, 2018	C	179,404	—	A	785,368	I	By OrbiMed Private Investments V, LP
Common Stock^F2,F3	Oct 19, 2018	P	200,000	$15.00	A	985,368	I	By OrbiMed Private Investments V, LP

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Series 6 Preferred Stock^F1,F2,F3	—	Oct 19, 2018	C	572,326	D	—	—	Common Stock	605,964	0	I
Series 7 Preferred Stock^F4,F2,F3	—	Oct 19, 2018	C	179,404	D	—	—	Common Stock	179,404	0	I

F1The 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.
F2Shares held by OrbiMed Private Investments V, LP. ("OPI V"). OrbiMed Capital GP V LLC ("GP V") is the general partner of OPI V and OrbiMed Advisors LLC ("OrbiMed Advisors") is the managing member of GP V. By virtue of such relationships, GP V and OrbiMed Advisors may be deemed to have voting and investment power with respect to the shares held by OPI V and as a result may be deemed to have beneficial ownership of such shares. Reporting Person, a member of Issuer's board of directors, is an employee of OrbiMed Advisors.
F3Each of GP V, OrbiMed Advisors and the Reporting Person disclaims beneficial ownership of the securities reported herein for purposes of Rule 16a-1(a) under the Securities Exchange Act of 1934, as amended (the "Exchange Act"), except to the extent of its or his pecuniary interest therein, if any. This report shall not be deemed an admission that any such entity or person is a beneficial owner of such securities for purpose of Section 16 of the Exchange Act, or for any other purpose.
F4The Issuer's 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.