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Filing Details

Accession Number:: 0001209191-18-055697
Form Type:: 4
Zero Holdings:: No
Publication Time:: 2018-10-19 16:48:04
Reporting Period:: 2018-10-19

Accepted Time:: 2018-10-19 16:48:04
SEC Url:: Form 4 Filing

Issuer

Cik	Name	Symbol	Sector (SIC)	IRS No
1459839	Si-Bone Inc.	SIBN	()	4

Insiders

Cik	Name	Reported Address	Insider Title	Director	Officer	Large Shareholder	Other
1296771	Gordon John Freund	C/O Skyline Ventures 525 University Avenue, Suite 1350 Palo Alto CA 94301		Yes	No	Yes	No

Reported Non-Derivative Transactions

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Sec. Name	Acquisiton - Disposition	Date	Amount	Price	Remaning Holdings	Equity Swap Involved	Form Type	Code	Nature of Ownership	Explanation
Common Stock	Acquisiton	2018-10-19	2,213,425	$0.00	2,213,425	No	4	C	Indirect	By Skyline Venture Partners V, L.P.
Common Stock	Acquisiton	2018-10-19	792,195	$0.00	3,005,620	No	4	C	Indirect	By Skyline Venture Partners V, L.P.
Common Stock	Acquisiton	2018-10-19	690,689	$0.00	3,696,309	No	4	C	Indirect	By Skyline Venture Partners V, L.P.
Common Stock	Acquisiton	2018-10-19	398,676	$0.00	4,094,985	No	4	C	Indirect	By Skyline Venture Partners V, L.P.
Common Stock	Acquisiton	2018-10-19	325,000	$15.00	4,419,985	No	4	P	Indirect	By Skyline Venture Partners V, L.P.

Equity Swap Involved	Form Type	Code	Nature of Ownership	Explanation
No	4	C	Indirect	By Skyline Venture Partners V, L.P.
No	4	C	Indirect	By Skyline Venture Partners V, L.P.
No	4	C	Indirect	By Skyline Venture Partners V, L.P.
No	4	C	Indirect	By Skyline Venture Partners V, L.P.
No	4	P	Indirect	By Skyline Venture Partners V, L.P.

Reported Derivative Transactions

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Sec. Name	Sec. Type	Acquisiton - Disposition	Date	Amount	Price	Amount - 2	Price - 2
Series 5 Preferred Stock	Warrant (right to buy)	Disposition	2018-10-19	39,421	$0.00	39,421	$9.10
Common Stock	Series 5 Preferred Stock	Acquisiton	2018-10-19	39,421	$0.00	39,421	$9.10
Common Stock	Series 5 Preferred Stock	Disposition	2018-10-19	23,904	$15.00	23,904	$0.00
Common Stock	Series 4 Preferred Stock	Disposition	2018-10-19	2,213,425	$0.00	2,213,425	$0.00
Common Stock	Series 5 Preferred Stock	Disposition	2018-10-19	792,195	$0.00	792,195	$0.00
Common Stock	Series 6 Preferred Stock	Disposition	2018-10-19	652,347	$0.00	690,689	$0.00
Common Stock	Series 7 Preferred Stock	Disposition	2018-10-19	398,676	$0.00	398,676	$0.00

Remaning Holdings	Equity Swap Involved	Transaction Form Type	Transaction Code	Nature of Ownership
0	No	4	X	Indirect
816,099	No	4	X	Indirect
792,195	No	4	S	Indirect
0	No	4	C	Indirect
0	No	4	C	Indirect
0	No	4	C	Indirect
0	No	4	C	Indirect

Footnotes

The Issuer's Series 4 Preferred Stock, Series 5 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.
Shares held by Skyline Venture Partners V, L.P. ("SVP V"). Skyline Venture Management V, LLC ("LLC") is the general partner of SVP V and as such may be deemed to have voting and investment power with respect to the securities of SVP V. Dr. Freund, a member of the Issuer's board of directors, together with Yasunori Kaneko, are the managing directors of LLC and each may be deemed to have voting and investment power with respect to the securities held by SVP V. Dr. Freund disclaims beneficial ownership of such securities, except to the extent of his pecuniary interest therein.
The 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.
Shares subject to the warrant are immediately exercisable. The warrant will expire in connection with the closing of the Issuer's initial public offering.
Immediately prior to the closing of the Issuer's initial public offering, SVP V exercised a warrant to purchase 39,421 shares of Series 5 Preferred Stock at an exercise price of $9.10 per share. The exercise price was paid on a net exercise cashless basis calculated using the Issuer's initial public offering price of $15.00, resulting in the Issuer withholding 23,904 of the warrant shares to pay the exercise price and issuing SVP V the remaining 15,517 shares.