SEC Form 4 · accession 0001209191-18-055701

SI-BONE, Inc. · SIBN

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

Reporting owners

ORBIMED ADVISORS LLC

Director

OrbiMed Capital GP V LLC

Director

Period of report

Oct 19, 2018

Accepted (ET)

Oct 19, 2018 · 4:52 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

Table II — derivative securities

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

Explanation of responses

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 have beneficial ownership of such shares. OrbiMed Advisors exercises investment and voting power through a management committee comprised of Carl L. Gordon, Sven H. Borho, and Jonathan T. Silverstein. David P. Bonita, a member of the Issuer's board of directors, is an employee of OrbiMed Advisors.
F3This report on Form 4 is jointly filed by GP V and OrbiMed Advisors. Each of the Reporting Persons 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 pecuniary interest therein, if any. This report shall not be deemed an admission that any such entity 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.