SEC Form 4 · accession 0001209191-18-055706
SI-BONE, Inc. · SIBN
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Mark A Reiley
Director
Period of report
Oct 19, 2018
Accepted (ET)
Oct 19, 2018 · 4:59 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 | Oct 19, 2018 | C | 8,680 | — | A | 523,180 | D | |
| Common StockF2 | holding | — | — | — | 19,444 | I | By Trust |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series 3 Preferred StockF1 | — | Oct 19, 2018 | C | 8,680 | D | — | — | Common Stock | 8,680 | 0 | D |
Explanation of responses
- F1The Issuer's Series 3 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.
- F2Shares held by The Mark and Muriel Riley Charitable Remainder Unitrust.