0001628280-18-009479.txt : 20180720 0001628280-18-009479.hdr.sgml : 20180720 20180720174428 ACCESSION NUMBER: 0001628280-18-009479 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180718 FILED AS OF DATE: 20180720 DATE AS OF CHANGE: 20180720 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: 18963211 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: 000000000 STATE OF INCORPORATION: D8 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_153212305287921.xml FORM 4 X0306 4 2018-07-18 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 Stock Option (Right to buy) 18.0 2018-07-18 4 A 0 250000 0 A Common Shares 250000.0 250000 D One-fourth of the shares subject to the option shall vest on July 18, 2019 and each one-year anniversary thereafter, subject to the Reporting Person continuing as a service provider through each such date. /s/ Renee Gaeta, by power of attorney 2018-07-19