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: Freund John Gordon (Director, 10% Owner)

Holdings (Derivative)

Security	Exercise Price	Expiration	Underlying	Shares	Ownership
Series 4 Preferred Stock	$		Common Stock (2213425)		Indirect
Series 5 Preferred Stock	$		Common Stock (776678)		Indirect
Series 6 Preferred Stock	$		Common Stock (652347)		Indirect
Series 7 Preferred Stock	$		Common Stock (398676)		Indirect
Warrant (right to buy)	$9.10		Series 5 Preferred Stock (39421)		Indirect
Stock Option (right to buy)	$5.94	2027-03-01	Common Stock (22222)		Direct

Footnotes

F1: The Issuer's Series 4 Preferred Stock, Series 5 Preferred Stock and 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 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.

F3: The Issuer's Series 6 Preferred Stock will automatically convert 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.

F4: Shares subject to the warrant are immediately exercisable. The warrant will expire in connection with the closing of the Issuer's initial public offering.

F5: 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.