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* Montreux Equity Partners IV, L.P. (Last) (First) (Middle) ONE FERRY BUILDING, SUITE 255 (Street) SAN FRANCISCO CA 94111 (City) (State) (Zip)	2. Date of Event Requiring Statement (Month/Day/Year) 10/16/2018	3. Issuer Name and Ticker or Trading Symbol SI-BONE, Inc. [ SIBN ]
		4. Relationship of Reporting Person(s) to Issuer (Check all applicable) Director X 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 X 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)
	Date Exercisable	Expiration Date	Title	Amount or Number of Shares
Series 5 Preferred Stock	(1)	(1)	Common Stock	1,096,816	(1)	I	By Montreux Equity Partners IV, L.P.(2)
Series 5 Preferred Stock	(1)	(1)	Common Stock	78,564	(1)	I	By Montreux IV Associates, LLC(2)
Series 6 Preferred Stock	(3)	(3)	Common Stock	563,926	(3)	I	By Montreux Equity Partners IV, L.P.(2)
Series 6 Preferred Stock	(3)	(3)	Common Stock	48,950	(3)	I	By Montreux IV Associates, LLC(2)
Series 7 Preferred Stock	(1)	(1)	Common Stock	27,409	(1)	I	By Montreux Equity Partners IV, L.P.(2)
Series 7 Preferred Stock	(1)	(1)	Common Stock	171,929	(1)	I	By Montreux IV Associates IV, LLC(2)
Warrant (right to buy)	(4)	(4)	Series 5 Preferred Stock	15,496	9.1	I	By Montreux Equity Partners IV, L.P.(2)

1. Name and Address of Reporting Person* Montreux Equity Partners IV, L.P. (Last) (First) (Middle) ONE FERRY BUILDING, SUITE 255 (Street) SAN FRANCISCO CA 94111 (City) (State) (Zip)

1. Name and Address of Reporting Person* Montreux IV Associates, LLC (Last) (First) (Middle) ONE FERRY BUILDING, SUITE 255 (Street) SAN FRANCISCO CA 94111 (City) (State) (Zip)

1. Name and Address of Reporting Person* Montreux IV Associates IV, LLC (Last) (First) (Middle) ONE FERRY BUILDING, SUITE 255 (Street) SAN FRANCISCO CA 94111 (City) (State) (Zip)

1. Name and Address of Reporting Person* Montreux Equity Management IV, LLC (Last) (First) (Middle) ONE FERRY BUILDING, SUITE 255 (Street) SAN FRANCISCO CA 94111 (City) (State) (Zip)

1. Name and Address of Reporting Person* TURNER DANIEL K III (Last) (First) (Middle) ONE FERRY BUILDING, SUITE 255 (Street) SAN FRANCISCO CA 94111 (City) (State) (Zip)

Explanation of Responses:

1. 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.

2. Montreux Equity Management IV, L.L.C. ("MEM IV LLC") is the general partner of each of Montreux Equity Partners IV, L.P., Montreux IV Associates, L.L.C and Montreux IV Associates IV, L.L.C. Daniel K. Turner III is the managing director of MEM IV LLC and may be deemed to have voting and investment power over the shares held by each of these entities. Mr. Turner disclaims beneficial ownership of such shares, except to the extent of his proportionate pecuniary interest, if any.

3. 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.

4. Shares subject to the warrant are immediately exercisable. The warrant will expire in connection with the closing of the Issuer's initial public offering.

Remarks:

	Montreux Equity Partners IV, L.P., By: Montreux Equity Management IV, L.L.C., Its: General Partner, By: /s/ Daniel K. Turner III, Managing Director	10/16/2018
	Montreux IV Associates, LLC, By: Montreux Equity Management IV, L.L.C., Its: General Partner, By: /s/ Daniel K. Turner III, Managing Director	10/16/2018
	Montreux IV Associates IV, LLC, By: Montreux Equity Management IV, L.L.C., Its: General Partner, By: /s/ Daniel K. Turner III, Managing Director	10/16/2018
	Montreux Equity Management IV, L.L.C., By: /s/ Daniel K. Turner III, Managing Director	10/16/2018
	/s/ Daniel K. Turner III	10/16/2018
	** Signature of Reporting Person	Date
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