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

Oct 16, 2018

SEC Form 3 — Initial Statement of Beneficial Ownership

Issuer: SI-BONE, Inc. (SIBN)
CIK: 0001459839
Period of Report: 2018-10-16

Reporting Person: Petersen Timothy (Director)

Holdings (Derivative)

Security	Exercise Price	Expiration	Underlying	Shares	Ownership
Series 7 Preferred Stock	$		Common Stock (1495036)		Indirect
Stock Option (right to buy)	$5.94	2027-03-01	Common Stock (22222)		Direct

Footnotes

F1: The Issuer's Series 7 Preferred Stock will automatically convert 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.

F3: The shares subject to the option vest in equal monthly installments over three years commencing on the closing date of the Issuer's initial public offering, subject to Reporting Person's continued service through each relevant vesting date.