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: HINCKLEY GREGORY K (Director)

Holdings (Non-Derivative)

Security	Shares	Ownership
Common Stock	12064	Direct
Common Stock	21111	Direct

Holdings (Derivative)

Security	Exercise Price	Expiration	Underlying	Shares	Ownership
Series 4 Preferred Stock	$		Common Stock (15873)		Direct
Series 6 Preferred Stock	$		Common Stock (12141)		Direct
Series 6 Preferred Stock	$		Common Stock (9106)		Direct
Series 7 Preferred Stock	$		Common Stock (44851)		Direct
Stock Option (right to buy)	$5.94	2027-03-01	Common Stock (22222)		Direct

Footnotes

F1: Shares held by Gregory K. Hinckley and Mary C. Hinckley as Community Property with the Right of Survivorship.

F2: The Issuer's Series 4 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.

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: 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.