0001628280-19-007595.txt : 20190605 0001628280-19-007595.hdr.sgml : 20190605 20190605164056 ACCESSION NUMBER: 0001628280-19-007595 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: Gersh Lisa CENTRAL INDEX KEY: 0001329958 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38593 FILM NUMBER: 19880207 MAIL ADDRESS: STREET 1: C/O HASBRO, INC. STREET 2: 1011 NEWPORT AVENUE CITY: PAWTUCKET STATE: RI ZIP: 02861 FORMER NAME: FORMER CONFORMED NAME: Hall Lisa Gersh DATE OF NAME CHANGE: 20050613 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_155976724160617.xml FORM 4 X0306 4 2019-06-03 0 0001688757 ESTABLISHMENT LABS HOLDINGS INC. ESTA 0001329958 Gersh Lisa 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 12000 0 A 2029-06-03 Common Shares 12000.0 12000 D One-third of the shares subject to the option vest on June 3, 2020 and each one-year anniversary thereafter, subject to the Reporting Person continuing as a service provider through each such date. /s/ Renee M. Gaeta, by power of attorney 2019-06-05