Form Type: 4

SEC EDGAR Link
Accession Number:0001562180-19-005865
Date:2019-12-03
Issuer: SI-BONE, INC. (SIBN)
Original Submission Date:

Reporting Person:

HILLEMAN JERYL L
C/O SI-BONE, INC.
471 EL CAMINO REAL, SUITE 101 SANTA CLARA, CA 95050

Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
Title of SecurityTransaction Date2a. Deemed Execution Date Transaction CodeSharesAcquired or DisposedPrice per share 5. Amount of Securities Beneficially Owned Following Reported Transaction 6. Ownership Form Direct or IndirectNature of Indirect Ownership
Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, convertible securities
Title of Derivative Security Conversion or Exercise Price of Derivative Security Transaction Date Deemed Execution Date Transaction Code Number of Derivative Securities Acquired (A) or Disposed of (D) Date ExercisableExpiration Date Title and Amount of Securities Underlying Derivative Security Price of Derivative Security Number of derivative Securities Beneficially Owned Following Reported Transaction(s) Ownership Form: Direct (D) or Indirect (I) Nature of Indirect Beneficial Ownership
STOCK OPTIONS (RIGHT TO BUY) 17.31 2019-12-03 deemed execution date A 26,236 (a) 2029-12-02 common stock 26,236 $17.31 26,236 direct
Footnotes
IDfootnote
f1 the shares subject to the option will vest in a series of 12 equal monthly increments over the one-year period following the vesting commencement date, such that the option will be fully vested on the first anniversary of the vesting commencement date, subject to the reporting person's continuous service as a member of the issuer's board of directors on such applicable vesting date.
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