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SI-BONE, Inc. Director's Dealing 2018

Oct 16, 2018

32647_dirs_2018-10-16_4c5bdbd0-47e6-40fa-9021-2fd8a322130a.zip

Director's Dealing

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SEC Form 3 — Initial Statement of Beneficial Ownership

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

Reporting Person: Skyline Venture Partners V LP (10% Owner)
Reporting Person: Skyline Venture Management V, LLC (10% Owner)
Reporting Person: Freund John Gordon (Director, 10% Owner)
Reporting Person: KANEKO YASUNORI (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

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. John G. 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 and Mr. Kaneko disclaim beneficial ownership of such securities, except to the extent of their 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.