0001628280-18-009511.txt : 20180723 0001628280-18-009511.hdr.sgml : 20180723 20180723162822 ACCESSION NUMBER: 0001628280-18-009511 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180723 FILED AS OF DATE: 20180723 DATE AS OF CHANGE: 20180723 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: COLLERAN LISA N CENTRAL INDEX KEY: 0001212312 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38593 FILM NUMBER: 18964702 MAIL ADDRESS: STREET 1: 0NE MILLENIUM WAY CITY: BRANCHBURG STATE: NJ ZIP: 08876 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ESTABLISHMENT LABS HOLDINGS INC. CENTRAL INDEX KEY: 0001688757 STANDARD INDUSTRIAL CLASSIFICATION: ORTHOPEDIC, PROSTHETIC & SURGICAL APPLIANCES & SUPPLIES [3842] IRS NUMBER: 000000000 STATE OF INCORPORATION: D8 BUSINESS ADDRESS: STREET 1: PO BOX 3140, COMMERCE HOUSE STREET 2: WICKHAMS CAY 1, ROAD TOWN CITY: TORTOLA STATE: D8 ZIP: VG1110 BUSINESS PHONE: 50624342400 MAIL ADDRESS: STREET 1: PO BOX 3140, COMMERCE HOUSE STREET 2: WICKHAMS CAY 1, ROAD TOWN CITY: TORTOLA STATE: D8 ZIP: VG1110 4 1 wf-form4_153237768270748.xml FORM 4 X0306 4 2018-07-23 0 0001688757 ESTABLISHMENT LABS HOLDINGS INC. ESTA 0001212312 COLLERAN LISA N C/O MOTIVA USA LLC 16192 COASTAL HIGHWAY LEWES DE 19958 1 0 0 0 Common Shares 2018-07-23 4 C 0 38931 A 38931 D Class A Ordinary Shares 2018-07-23 4 C 0 12699 0 D Common Shares 12699.0 0 D Class C Ordinary Shares 2018-07-23 4 C 0 26232 0 D Common Shares 26232.0 0 D The Class A Ordinary Shares automatically converted into Common Shares on a one-for-one basis upon the closing of the Issuer's initial public offering of Common Shares and had no expiration date. /s/ Renee Gaeta, by power of attorney 2018-07-23