0001628280-21-011127.txt : 20210526 0001628280-21-011127.hdr.sgml : 20210526 20210526163821 ACCESSION NUMBER: 0001628280-21-011127 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210525 FILED AS OF DATE: 20210526 DATE AS OF CHANGE: 20210526 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: 21966879 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_162206148133767.xml FORM 4 X0306 4 2021-05-25 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) 78.11 2021-05-25 4 A 0 10000 0 A 2031-05-25 Common Shares 10000.0 10000 D The shares subject to the option vest in full on the earlier of May 25, 2022 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 2021-05-26