0001398327-19-000002.txt : 20190521
0001398327-19-000002.hdr.sgml : 20190521
20190521125421
ACCESSION NUMBER: 0001398327-19-000002
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190520
FILED AS OF DATE: 20190521
DATE AS OF CHANGE: 20190521
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: LEWIN NICHOLAS SHERIDAN
CENTRAL INDEX KEY: 0001398327
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38593
FILM NUMBER: 19841697
MAIL ADDRESS:
STREET 1: 3 WEST 57TH ST.
STREET 2: 8TH FLOOR
CITY: NEW YORK
STATE: NY
ZIP: 10019
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_155845764614407.xml
FORM 4
X0306
4
2019-05-20
0
0001688757
ESTABLISHMENT LABS HOLDINGS INC.
ESTA
0001398327
LEWIN NICHOLAS SHERIDAN
C/O MOTIVA USA LLC
16192 COASTAL HIGHWAY
LEWES
DE
19958
1
0
1
0
Common Shares
2019-05-20
4
J
0
7516131
0
D
0
I
See Footnote
Common Shares
2019-05-20
4
J
0
408470
0
A
408470
D
Common Shares
2019-05-20
4
J
0
646800
0
A
646800
I
See Footnote
The shares are held by CPH TU, LP ("CPH TU"), of which the Reporting Person is a managing partner. CPH TU distributed the shares to its partners on a pro rata basis (the "Distribution").
The shares were acquired by the Reporting Person as a result of the Distribution. The acquisition of the shares is exempt pursuant to Rule16a-9.
The shares are held by Crown Predator Holdings IV, LLC, of which the Reporting Person is a managing member. The Reporting Person disclaims beneficial ownership of the shares, except to the extent of his pecuniary interest therein.
/s/ Renee M. Gaeta, by power of attorney
2019-05-21