0001459839-16-000002.txt : 20160617 0001459839-16-000002.hdr.sgml : 20160617 20160617130022 ACCESSION NUMBER: 0001459839-16-000002 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20160617 DATE AS OF CHANGE: 20160617 EFFECTIVENESS DATE: 20160617 FILER: COMPANY DATA: COMPANY CONFORMED NAME: SI-BONE, Inc. CENTRAL INDEX KEY: 0001459839 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 262216351 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-265301 FILM NUMBER: 161719537 BUSINESS ADDRESS: STREET 1: 3055 OLIN AVENUE STREET 2: SUITE 2200 CITY: SAN JOSE STATE: CA ZIP: 95128 BUSINESS PHONE: 4082070700 MAIL ADDRESS: STREET 1: 3055 OLIN AVENUE STREET 2: SUITE 2200 CITY: SAN JOSE STATE: CA ZIP: 95128 FORMER COMPANY: FORMER CONFORMED NAME: SI-Bone Inc. DATE OF NAME CHANGE: 20090326 D 1 primary_doc.xml X0707 D LIVE 0001459839 SI-BONE, Inc. 3055 OLIN AVENUE SUITE 2200 SAN JOSE CA CALIFORNIA 95128 4082070700 DELAWARE SI-Bone Inc. Corporation true Jeffrey W. Dunn c/o SI-BONE, Inc. 3055 Olin Avenue, Suite 2200 San Jose CA CALIFORNIA 95128 Executive Officer Director David Bonita c/o SI-BONE, Inc. 3055 Olin Avenue, Suite 2200 San Jose CA CALIFORNIA 95128 Director Timothy E. Davis c/o SI-BONE, Inc. 3055 Olin Avenue, Suite 2200 San Jose CA CALIFORNIA 95128 Director John G. Freund c/o SI-BONE, Inc. 3055 Olin Avenue, Suite 2200 San Jose CA CALIFORNIA 95128 Director Gregory K. Hinckley c/o SI-BONE, Inc. 3055 Olin Avenue, Suite 2200 San Jose CA CALIFORNIA 95128 Director Karen A. Licitra c/o SI-BONE, Inc. 3055 Olin Avenue, Suite 2200 San Jose CA CALIFORNIA 95128 Director Mark A. Reiley c/o SI-BONE, Inc. 3055 Olin Avenue, Suite 2200 San Jose CA CALIFORNIA 95128 Director Keith C. Valentine c/o SI-BONE, Inc. 3055 Olin Avenue, Suite 2200 San Jose CA CALIFORNIA 95128 Director Robert E. Johnson c/o SI-BONE, Inc. 3055 Olin Avenue, Suite 2200 San Jose CA CALIFORNIA 95128 Executive Officer Laura Francis c/o SI-BONE, Inc. 3055 Olin Avenue, Suite 2200 San Jose CA CALIFORNIA 95128 Executive Officer Other Decline to Disclose 06b false 2016-06-02 false true false 0 20999999 19999999 1000000 false 9 0 0 0 false SI-BONE, Inc. /s/ Robert E. Johnson Robert E. Johnson General Counsel and Corporate Secretary 2016-06-17