0001742429-22-000006.txt : 20220412
0001742429-22-000006.hdr.sgml : 20220412
20220412191720
ACCESSION NUMBER: 0001742429-22-000006
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220410
FILED AS OF DATE: 20220412
DATE AS OF CHANGE: 20220412
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Chacon Quiros Juan Jose
CENTRAL INDEX KEY: 0001742429
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38593
FILM NUMBER: 22823326
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: Quiros Juan Jose Chacon
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: 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_164980542571828.xml
FORM 4
X0306
4
2022-04-10
0
0001688757
ESTABLISHMENT LABS HOLDINGS INC.
ESTA
0001742429
Chacon Quiros Juan Jose
C/O MOTIVA USA LLC
16192 COASTAL HIGHWAY
LEWES
DE
19958
1
1
0
0
Chief Executive Officer
Common Shares
2022-04-10
4
A
0
10464
0
A
204704
D
Common Shares
1128264
I
See Footnote
Stock Option (Right to buy)
63.53
2022-04-10
4
A
0
27524
0
A
2032-04-10
Common Shares
27524.0
27524
D
Represents an award of stock units under the Issuer's 2018 Equity Incentive Plan. One-fourth of the shares subject to the award shall vest on April 10, 2023 and each one-year anniversary thereafter, subject to the Reporting Person continuing as a service provider through such date.
The shares are held by Sariel LLC. The Reporting Person is a shareholder of Sariel LLC and has voting and dispositive power over the shares owned by Sariel LLC. The Reporting Person disclaims beneficial ownership of the shares held by Sariel LLC, except to the extent of his pecuniary interest therein.
One-fourth of the shares subject to the option shall vest on April 10, 2023 and each one-year anniversary thereafter, subject to the Reporting Person continuing as a service provider through such date.
/s/ Rajbir S. Denhoy, by power of attorney
2022-04-12