0001628280-19-007592.txt : 20190605 0001628280-19-007592.hdr.sgml : 20190605 20190605163855 ACCESSION NUMBER: 0001628280-19-007592 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190603 FILED AS OF DATE: 20190605 DATE AS OF CHANGE: 20190605 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: 19880172 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: 981436377 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_155976709945827.xml FORM 4 X0306 4 2019-06-03 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 Stock Option (Right to buy) 23.05 2019-06-03 4 A 0 10000 0 A 2029-06-03 Common Shares 10000.0 10000 D The shares subject to the option vest in full on the earlier of June 3, 2020 or the day prior to the date of the Issuer's next annual meeting of stockholders, subject to the Reporting Person continuing as a service provider through such date. /s/ Renee M. Gaeta, by power of attorney 2019-06-05