SI-BONE, Inc. — Director's Dealing 2018

Oct 19, 2018

SEC Form 4 — Statement of Changes in Beneficial Ownership

Issuer: SI-BONE, Inc. (SIBN)
CIK: 0001459839
Period of Report: 2018-10-19

Reporting Person: Petersen Timothy (Director)

Non-Derivative Transactions

Date	Security	Code	Shares	Price	A/D	Holdings After	Ownership
2018-10-19	Common Stock	C	1495036	—	Acquired	1495036	Indirect
2018-10-19	Common Stock	P	200000	$15.00	Acquired	1695036	Indirect

Derivative Transactions

Date	Security	Exercise Price	Code	Shares	A/D	Expiration	Underlying	Ownership
2018-10-19	Series 7 Preferred Stock	$	C	1495036	Disposed		Common Stock (1495036)	Indirect

Footnotes

F1: The Issuer's 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.

F2: Shares held by Arboretum Ventures IV, LP ("AV IV"). Arboretum Investment Manager IV, LLC ("AIM IV") serves as the general partner of AV IV. Jan Garfinkle, Timothy B. Petersen, a member of the Issuer's board of directors, and Paul McCreadie are managing members of AIM IV and share voting and dispositive power with regard to these shares and therefore each of the foregoing managing members may be deemed to have the same powers with respect to such shares. Mr. Petersen disclaims beneficial ownership of such shares except to the extent of his proportionate pecuniary interest, if any.