0001628280-18-009506.txt : 20180723
0001628280-18-009506.hdr.sgml : 20180723
20180723162621
ACCESSION NUMBER: 0001628280-18-009506
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20180723
FILED AS OF DATE: 20180723
DATE AS OF CHANGE: 20180723
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Dada Santos Salvador
CENTRAL INDEX KEY: 0001742431
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38593
FILM NUMBER: 18964686
MAIL ADDRESS:
STREET 1: C/O MOTIVA USA LLC
STREET 2: 16192 COASTAL HIGHWAY
CITY: LEWES
STATE: DE
ZIP: 19958
FORMER NAME:
FORMER CONFORMED NAME: Santos Salvador Dada
DATE OF NAME CHANGE: 20180601
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_153237756543818.xml
FORM 4
X0306
4
2018-07-23
0
0001688757
ESTABLISHMENT LABS HOLDINGS INC.
ESTA
0001742431
Dada Santos Salvador
C/O MOTIVA USA LLC
16192 COASTAL HIGHWAY
LEWES
DE
19958
0
1
0
0
Chief Operating Officer
Common Shares
2018-07-23
4
C
0
121053
A
121053
D
Class A Ordinary Shares
2018-07-23
4
C
0
121053
0
D
Common Shares
121053.0
0
D
The Class A Ordinary Shares automatically converted into Common Shares on a one-for-one basis upon the closing of the Issuer's initial public offering of Common Shares and had no expiration date.
/s/ Renee Gaeta, by power of attorney
2018-07-23