Form 4 for SI SHOULDER INNOVATIONS, INC.
Accepted 2025-08-05 00:00:00 ET · period of report 2025-08-01 · accession 0001641172-25-022243 · SEC index · Original document
Summary rows
Aggregated the way they appear in lists: one row per insider, transaction code and security table.
| X | Filed | Traded | Ticker | Insider | Title | Type | Price | Qty | Owned | ΔOwn | Value |
|---|---|---|---|---|---|---|---|---|---|---|---|
| D | 2025-08-05 | 2025-08-01 | SI | Blue David Lawrence | SEE REMARKS | C - Cnv Deriv | — | +43.9K | 43.9K | New | — |
| DMI | 2025-08-05 | 2025-08-01 | SI | Blue David Lawrence | SEE REMARKS | C - Cnv Deriv | — | -838.4K | 0 | -100% | — |
Purchase Sale Sale after option exercise All abbreviations
Every reported transaction
| # | Table | Security | Date | Code | A/D | Shares | Price | Owned after | Own | Exercise / expiry | Underlying | Footnotes |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Common | Common Stock | 2025-08-01 | C | A | 43,937 | — | 43,937 | D | — | — | (F1) Immediately prior to the closing of the Issuer's initial public offering, the shares of preferred stock of the Issuer automatically converted into shares of Common Stock on a one-for-0.052410901 basis. |
| 2 | Derivative | Series Seed Convertible Preferred Stock | 2025-08-01 | C | D | 100,000 | — | 0 | I By David Lawrence Blue Living Trust | — · — to — | 5,241 Common Stock | (F1) Immediately prior to the closing of the Issuer's initial public offering, the shares of preferred stock of the Issuer automatically converted into shares of Common Stock on a one-for-0.052410901 basis. |
| 3 | Derivative | Series A Convertible Preferred Stock | 2025-08-01 | C | D | 346,333 | — | 0 | I By David Lawrence Blue Living Trust | — · — to — | 18,151 Common Stock | (F1) Immediately prior to the closing of the Issuer's initial public offering, the shares of preferred stock of the Issuer automatically converted into shares of Common Stock on a one-for-0.052410901 basis. |
| 4 | Derivative | Series B Convertible Preferred Stock | 2025-08-01 | C | D | 308,916 | — | 0 | I By David Lawrence Blue Living Trust | — · — to — | 16,190 Common Stock | (F1) Immediately prior to the closing of the Issuer's initial public offering, the shares of preferred stock of the Issuer automatically converted into shares of Common Stock on a one-for-0.052410901 basis. |
| 5 | Derivative | Series C Convertible Preferred Stock | 2025-08-01 | C | D | 46,512 | — | 0 | I By David Lawrence Blue Living Trust | — · — to — | 2,437 Common Stock | (F1) Immediately prior to the closing of the Issuer's initial public offering, the shares of preferred stock of the Issuer automatically converted into shares of Common Stock on a one-for-0.052410901 basis. |
| 6 | Derivative | Series E Convertible Preferred Stock | 2025-08-01 | C | D | 36,614 | — | 0 | I By David Lawrence Blue Living Trust | — · — to — | 1,918 Common Stock | (F1) Immediately prior to the closing of the Issuer's initial public offering, the shares of preferred stock of the Issuer automatically converted into shares of Common Stock on a one-for-0.052410901 basis. |