SEC Form 4 · accession 0001209191-18-055703

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 · 4:57 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
Common Stock^F1	Oct 19, 2018	C	15,873	—	A	27,937	D
Common Stock^F2	Oct 19, 2018	C	12,854	—	A	40,791	D
Common Stock^F2,F3	Oct 19, 2018	C	9,641	—	A	30,752	D
Common Stock^F1,F3	Oct 19, 2018	C	44,851	—	A	75,603	D

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	D/I
Series 4 Preferred Stock^F1	—	Oct 19, 2018	C	15,873	D	—	—	Common Stock	15,873	D
Series 6 Preferred Stock^F2	—	Oct 19, 2018	C	12,141	D	—	—	Common Stock	12,854	D
Series 6 Preferred Stock^F2,F3	—	Oct 19, 2018	C	9,106	D	—	—	Common Stock	9,641	D
Series 7 Preferred Stock^F1,F3	—	Oct 19, 2018	C	44,851	D	—	—	Common Stock	44,851	D

F1The Issuer's Series 4 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.
F2The 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.
F3Shares held by Gregory K. Hinckley and Mary C. Hinckley as Community Property with the Right of Survivorship.