| UNITED STATES |
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| SECURITIES AND EXCHANGE COMMISSION |
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| Washington, D.C. 20549 |
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SCHEDULE 13G
(Rule 13d-102)
INFORMATION TO BE INCLUDED IN STATEMENTS FILED PURSUANT TO RULES 13d-1 (b),
(c) AND (d) AND AMENDMENTS THERETO FILED PURSUANT TO 13d-2 (b)
(Amendment No. )*
SI-BONE, INC.
(Name of Issuer)
COMMON STOCK, PAR VALUE $0.0001 PER SHARE
(Title of Class of Securities)
825704109
(CUSIP Number)
DECEMBER 31, 2018
(Date of Event Which Requires Filing of this Statement)
Check the appropriate box to designate the rule pursuant to which this Schedule is filed:
o | Rule 13d-1(b) |
o | Rule 13d-1(c) |
x | Rule 13d-1(d) |
*The remainder of this cover page shall be filled out for a reporting person's initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page.
The information required in the remainder of this cover page shall not be deemed to be "filed" for the purpose of Section 18 of the Securities Exchange Act of 1934 ("Act") or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).
CUSIP No. 825704109 | |||||
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| 1. | Name of Reporting Persons | |||
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| 2. | Check the Appropriate Box if a Member of a Group (See Instructions) | |||
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| (a) | o | ||
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| (b) | x (1) | ||
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| 3. | SEC Use Only | |||
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| 4. | Citizenship or Place of Organization | |||
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Number of | 5. | Sole Voting Power | |||
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6. | Shared Voting Power | ||||
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7. | Sole Dispositive Power | ||||
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8. | Shared Dispositive Power | ||||
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| 9. | Aggregate Amount Beneficially Owned by Each Reporting Person | |||
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| 10. | Check if the Aggregate Amount in Row (9) Excludes Certain Shares (See Instructions) | |||
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| 11. | Percent of Class Represented by Amount in Row (9) | |||
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| 12. | Type of Reporting Person (See Instructions) | |||
(1) This Schedule 13G is filed by Skyline Venture Partners V, L.P. (“SVP V”), Skyline Venture Management V, LLC (“SVM V”) , John G. Freund (“Freund”) and Yasunori Kaneko (“Kaneko” and together with SVP V, SVM V and Freund the “Skyline Entities”). The Skyline Entities expressly disclaim status as a “group” for purposes of this Schedule 13G.
(2) The shares are held by SVP V. SVM V is the sole general partner of SVP V. Freund and Kaneko are managing directors of SVM V and share voting and dispositive power over the shares held by the SVP V.
(3) This percentage is calculated based upon 24,335,690 shares of the Issuer’s common stock outstanding as of November 28, 2018 as set forth in the Issuers most recent 10-Q, filed with the Securities and Exchange Commission on November 29, 2018.
CUSIP No. 825704109 | |||||
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| 1. | Name of Reporting Persons | |||
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| 2. | Check the Appropriate Box if a Member of a Group (See Instructions) | |||
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| (a) | o | ||
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| (b) | x (1) | ||
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| 3. | SEC Use Only | |||
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| 4. | Citizenship or Place of Organization | |||
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Number of | 5. | Sole Voting Power | |||
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6. | Shared Voting Power | ||||
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7. | Sole Dispositive Power | ||||
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8. | Shared Dispositive Power | ||||
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| 9. | Aggregate Amount Beneficially Owned by Each Reporting Person | |||
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| 10. | Check if the Aggregate Amount in Row (9) Excludes Certain Shares (See Instructions) | |||
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| 11. | Percent of Class Represented by Amount in Row (9) | |||
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| 12. | Type of Reporting Person (See Instructions) | |||
(1) This Schedule 13G is filed by Skyline Venture Partners V, L.P. (“SVP V”), Skyline Venture Management V, LLC (“SVM V”) , John G. Freund (“Freund”) and Yasunori Kaneko (“Kaneko” and together with SVP V, SVM V and Freund the “Skyline Entities”). The Skyline Entities expressly disclaim status as a “group” for purposes of this Schedule 13G.
(2) The shares are held by SVP V. SVM V is the sole general partner of SVP V. Freund and Kaneko are managing directors of SVM V and share voting and dispositive power over the shares held by the SVP V.
(3) This percentage is calculated based upon 24,335,690 shares of the Issuer’s common stock outstanding as of November 28, 2018 as set forth in the Issuers most recent 10-Q, filed with the Securities and Exchange Commission on November 29, 2018.
CUSIP No. 825704109 | |||||
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| 1. | Name of Reporting Persons | |||
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| 2. | Check the Appropriate Box if a Member of a Group (See Instructions) | |||
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| (a) | o | ||
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| (b) | x (1) | ||
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| 3. | SEC Use Only | |||
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| 4. | Citizenship or Place of Organization | |||
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Number of | 5. | Sole Voting Power | |||
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6. | Shared Voting Power | ||||
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7. | Sole Dispositive Power | ||||
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8. | Shared Dispositive Power | ||||
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| 9. | Aggregate Amount Beneficially Owned by Each Reporting Person | |||
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| 10. | Check if the Aggregate Amount in Row (9) Excludes Certain Shares (See Instructions) | |||
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| 11. | Percent of Class Represented by Amount in Row (9) | |||
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| 12. | Type of Reporting Person (See Instructions) | |||
(1) This Schedule 13G is filed by Skyline Venture Partners V, L.P. (“SVP V”), Skyline Venture Management V, LLC (“SVM V”) , John G. Freund (“Freund”) and Yasunori Kaneko (“Kaneko” and together with SVP V, SVM V and Freund the “Skyline Entities”). The Skyline Entities expressly disclaim status as a “group” for purposes of this Schedule 13G.
(2) The shares are held by SVP V. SVM V is the sole general partner of SVP V. Freund and Kaneko are managing directors of SVM V and share voting and dispositive power over the shares held by the SVP V.
(3) This percentage is calculated based upon 24,335,690 shares of the Issuer’s common stock outstanding as of November 28, 2018 as set forth in the Issuers most recent 10-Q, filed with the Securities and Exchange Commission on November 29, 2018.
CUSIP No. 825704109 | |||||
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| 1. | Name of Reporting Persons | |||
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| 2. | Check the Appropriate Box if a Member of a Group (See Instructions) | |||
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| (a) | o | ||
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| (b) | x (1) | ||
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| 3. | SEC Use Only | |||
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| 4. | Citizenship or Place of Organization | |||
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Number of | 5. | Sole Voting Power | |||
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6. | Shared Voting Power | ||||
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7. | Sole Dispositive Power | ||||
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8. | Shared Dispositive Power | ||||
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| 9. | Aggregate Amount Beneficially Owned by Each Reporting Person | |||
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| 10. | Check if the Aggregate Amount in Row (9) Excludes Certain Shares (See Instructions) | |||
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| 11. | Percent of Class Represented by Amount in Row (9) | |||
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| 12. | Type of Reporting Person (See Instructions) | |||
(1) This Schedule 13G is filed by Skyline Venture Partners V, L.P. (“SVP V”), Skyline Venture Management V, LLC (“SVM V”) , John G. Freund (“Freund”) and Yasunori Kaneko (“Kaneko” and together with SVP V, SVM V and Freund the “Skyline Entities”). The Skyline Entities expressly disclaim status as a “group” for purposes of this Schedule 13G.
(2) The shares are held by SVP V. SVM V is the sole general partner of SVP V. Freund and Kaneko are managing directors of SVM V and share voting and dispositive power over the shares held by the SVP V.
(3) This percentage is calculated based upon 24,335,690 shares of the Issuer’s common stock outstanding as of November 28, 2018 as set forth in the Issuers most recent 10-Q, filed with the Securities and Exchange Commission on November 29, 2018.
CUSIP No. 825704109 |
Introductory Note: This Statement on Schedule 13G is filed on behalf of Skyline Venture Partners V, L.P., a limited partnership organized under the laws of the State of Delaware (“SVP V”), Skyline Venture Management V, LLC, a limited liability company organized under the laws of the State of Delaware (“SVP V”), John G. Freund (“Freund”) and Yasunori Kaneko (“Kaneko”, and together with SVP V, SVM V and Freund, the “Skyline Entities”) in respect of shares of Common Stock of SI-BONE, Inc.
Item 1(a) | Name of Issuer |
Item 1(b) | Address of Issuer’s Principal Executive Offices Santa Clara, CA 95050 |
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Item 2(a) | Name of Person Filing Skyline Venture Management V, LLC John G. Freund Yasunori Kaneko |
Item 2(b) | Address of Principal Business Office or, if none, Residence Palo Alto, CA 94301 |
Item 2(c) | Citizenship |
Item 2(d) | Title of Class of Securities |
Item 2(e) | CUSIP Number |
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Item 3 | Not applicable. |
CUSIP No. 825704109 |
Item 4 | Ownership |
Skyline Entity |
| Shares Held |
| Sole |
| Shared |
| Sole Dispositive |
| Shared Power |
| Beneficial |
| Percentage |
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Skyline Venture Partners V, L.P. (1) |
| 4,419,985 |
| 0 |
| 4,419,985 |
| 0 |
| 4,419,985 |
| 4,419,985 |
| 18.2 | % |
Skyline Venture Management V, LLC (1) |
| 0 |
| 0 |
| 4,419,985 |
| 0 |
| 4,419,985 |
| 4,419,985 |
| 18.2 | % |
Yasunori Kaneko (1) |
| 0 |
| 0 |
| 4,419,985 |
| 0 |
| 4,419,985 |
| 4,419,985 |
| 18.2 | % |
John G. Freund (1) |
| 0 |
| 0 |
| 4,419,985 |
| 0 |
| 4,419,985 |
| 4,419,985 |
| 18.2 | % |
(1) The shares are held by SVP V. SVM V is the sole general partner of SVP V. Freund and Kaneko are managing directors of SVM V and share voting and dispositive power over the shares held by the SVP V.
(2) This percentage is calculated based upon 24,335,690 shares of the Issuer’s common stock outstanding as of November 28, 2018 as set forth in the Issuers most recent 10-Q, filed with the Securities and Exchange Commission on November 29, 2018.
Item 5 | Ownership of Five Percent or Less of a Class |
If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more than five percent of the class of securities, check the following o. | |
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Item 6 | Ownership of More than Five Percent of Another Person |
Not applicable. | |
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Item 7 | Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the Parent Holding Company |
Not applicable. | |
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Item 8 | Identification and Classification of Members of the Group |
Not applicable. | |
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Item 9 | Notice of Dissolution of Group |
Not applicable. |
CUSIP No. 825704109 |
Item 10 | Certification |
Not applicable. |
SIGNATURE
After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this Statement is true, complete and correct.
February 14, 2019 | SKYLINE VENTURE PARTNERS V, L.P. | |
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| BY: | SKYLINE VENTURE MANAGEMENT V, LLC |
| ITS: | GENERAL PARTNER |
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| By: | /s/ Kerensa Kenny as attorney-in-fact |
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| John G. Freund |
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| Managing Director |
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| SKYLINE VENTURE MANAGEMENT V, LLC | |
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| By: | /s/ Kerensa Kenny as attorney-in-fact |
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| John G. Freund |
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| Managing Member |
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| /s/ Kerensa Kenny as attorney-in-fact |
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| YASUNORI KANEKO |
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| /s/ Kerensa Kenny as attorney-in-fact |
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| JOHN G. FREUND |