Form D
View Original Filing
Notice of Exempt Offering of Securities
Item 1. Issuer's Identity
Name of Issuer:
SI-BONE INC.
Jurisdiction of Incorporation/Organization
DE
Year of Incorporation/Organization
2008
Item 2 Issuer Principal Place of Business and Contact Information
550 S WINCHESTER BOULEVARD SUITE 620
SAN JOSE, CA 95128
Phone Number:
subscription required
Item 3. Related Persons
Name
JEFFREY W. DUNN
Address
subscription required
Relationship(s)
- EXECUTIVE OFFICER
- DIRECTOR
Clarification of Response
Item 3. Related Persons
Name
MARK A. REILEY
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
TED DAVIS
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
DAN MURRAY
Address
subscription required
Relationship(s)
Clarification of Response
Item 4. Industry Group
OTHER HEALTH CARE
Item 5. Issuer Size
Revenue Range (for issuer not specifying "hedge" or "other investment" fund in Item 4 above)
DECLINE TO DISCLOSE
Item 6. Federal Exemptions and Exclusions Claimed
Item 7. Type of Filing
New Notice
Date of First Sale in this Offering:
08/03/2010
Item 8. Duration of Offering
Does the issuer intend this offering to last more than one year?
No
Item 9. Type(s) of Securities Offered
Item 10. Business Combination Transaction
Is this offering being made in connection with a business combination
transaction, such as a merger, acquisition or exchange offer?
No
Clarification of Response
Item 11. Minimum Investment
Minimum Investment accepted from any outside investor
25000
Item 13. Offering and Sales Amounts
Total Offering Amount
11000000
Total Amount Sold
10607038
Total Remaining to be Sold
392962
Clarification of Response
Item 14. Investors
Securities in the offering have been or may be sold to persons
who do not qualify as accredited investors,
Number of non-accredited investors who already have invested in the offering:
Total number of investors who already have invested in the offering:
19
Item 15. Sales Commissions and Finders' Fees Expenses
Sales Commissions:
0.0
Finders' Fees
0.0
Clarification of Response
Item 16. Use of Proceeds
Provide the amount of the gross proceeds of the offering
that has been or is proposed to be used for payments to any of the persons required
to be named as executive officers,directors or promoters in response to Item 3 above.
0.0
Clarification of Response
Signature and Submission
Issuer Name
SI-BONE INC.
Issuer Signature
DAN MURRAY
Signer Name
DAN MURRAY
Signer Title
CFO
Signature Date
08/16/2010