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: Valentine Keith (Director)

Holdings (Non-Derivative)

Security	Shares	Ownership
Common Stock	21408	Direct

Holdings (Derivative)

Security	Exercise Price	Expiration	Underlying	Shares	Ownership
Series 7 Preferred Stock	$		Common Stock (9966)		Direct
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: 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.