SEC Filing | SI-BONE, Inc.

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SEC FORM 3 SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940

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1. Name and Address of Reporting Person^*

West Thomas A.

(Last)

(First)

(Middle)

C/O SI-BONE, INC.

471 EL CAMINO REAL, SUITE 101

(Street)

SANTA CLARA

95050

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
06/25/2024

3. Issuer Name and Ticker or Trading Symbol
SI-BONE, Inc. [ SIBN ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

	Director		10% Owner
	Officer (give title below)		Other (specify below)

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)

Explanation of Responses:

Remarks:

No securities are beneficially owned.

	/s /Michael Pisetsky, Attorney-in-Fact for Thomas A. West	06/27/2024
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.

POWER OF ATTORNEY
        Know all by these presents, that the undersigned hereby
constitutes and appoints each of LAURA A. FRANCIS and MICHAEL A.
PISETSKY of SI-BONE, Inc. (the "Company") and MATTHEW B. HEMINGTON,
JOHN T. MCKENNA, KATE NICHOLS and KRIS TAMASHIRO of Cooley LLP, signing
individually, the undersigned's true and lawful attorneys-in-
fact and agents to:
        (1)	Prepare, execute in the undersigned's name and on
the undersigned's behalf, and submit to the Securities and
Exchange Commission (the "SEC"), a Form ID, Uniform Application
for Access Codes to File on EDGAR, including amendments thereto,
and any other documents necessary or appropriate to obtain codes
and passwords enabling the undersigned to make electronic
filings with the SEC of reports required by Section 16(a) of the
Securities Exchange Act of 1934, as amended (the "Exchange
Act"), or any rule or regulation thereunder;
        (2)	Prepare, execute in the undersigned's name and on
the undersigned's behalf, and submit to the SEC Forms 3, 4, and
5 (including amendments thereto and joint filing agreements in
connection therewith) in accordance with Section 16(a) of the
Exchange Act and the rules thereunder in the undersigned's
capacity as an officer, director, or beneficial owner of more
than 10% of a registered class of securities of the Company;
        (3)	Do and perform any and all acts for and on behalf of
the undersigned that may be necessary or desirable to prepare
and execute any such Form 3, 4, or 5 (including amendments
thereto and joint filing agreements in connection therewith) and
file such forms with the SEC and any stock exchange, self-
regulatory association or any similar authority; and
        (4)	Take any other action of any type whatsoever in
connection with the foregoing that, in the opinion of such
attorney-in-fact, may be of benefit to, in the best interest of,
or legally required of the undersigned, it being understood that
the documents executed by the attorney-in-fact on behalf of the
undersigned pursuant to this Power of Attorney shall be in such
form and shall contain such terms and conditions as the
attorney-in-fact may approve in the attorney-in-fact's
discretion.
        The undersigned hereby grants to each such
attorney-in-fact full power and authority to do and perform any
and every act and thing whatsoever requisite, necessary, or
proper to be done in the exercise of any of the rights and
powers herein granted, as fully to all intents and purposes as
the undersigned might or could do if personally present, with
full power of substitution or revocation, hereby ratifying and
confirming all that such attorney-in-fact, or such
attorney-in-fact's substitute or substitutes, shall lawfully do
or cause to be done by virtue of this power of attorney and the
rights and powers herein granted.  The undersigned acknowledges
that the foregoing attorneys-in-fact, and their substitutes, in
serving in such capacity at the request of the undersigned, are
not assuming (nor is the Company assuming) any of the
undersigned's responsibilities to comply with Section 16 of the
Exchange Act.
        This Power of Attorney shall remain in full force and
effect until the earliest to occur of the following: (a) the
undersigned is no longer required to file Forms 3, 4, and 5 with
respect to the undersigned's holdings of, and transactions in,
securities issued by the Company, (b) revocation by the
undersigned in a signed writing delivered to the Company and the
foregoing attorneys-in fact, or (c) as to any attorney-in-fact
individually, until such attorney-in-fact is no longer employed
by the Company or Cooley LLP, as applicable.
        IN WITNESS WHEREOF, the undersigned has caused this Power of
Attorney to be executed as of the date written below.

Thomas A. West						Date June 7th, 2024