SEC Form 4 · accession 0001209191-19-004388
SI-BONE, Inc. · SIBN
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Jeffrey W Dunn
Officer — Chairman, President & CEO · Director
Period of report
Jan 15, 2019
Accepted (ET)
Jan 17, 2019 · 6:42 pm EST
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 | Jan 15, 2019 | A | 68,100 | $0.00 | A | 101,433 | D | |
| Common StockF2 | holding | — | — | — | 547,540 | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (right to buy)F3 | $22.00 | Jan 15, 2019 | A | 147,500 | A | — | Jan 15, 2029 | Common Stock | 147,500 | 147,500 | D |
Explanation of responses
- F1Reflects shares issuable on settlement of restricted stock units granted to the Reporting Person. Each restricted stock unit represents a contingent right to receive one shares of the Issuer's common stock. The restricted stock unit will vest in equal quarterly installments over four years commencing on January 15, 2019, subject to the Reporting Person's continued service through each relevant vesting date.
- F2Shares held by The Jeffrey W. Dunn Living Trust Dated May 17, 2012.
- F3The shares subject to the option vest in equal monthly installments over four years commencing on January 15, 2019, subject to the Reporting Person's continued service through each relevant vesting date.