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