0001743936-19-000004.txt : 20190429 0001743936-19-000004.hdr.sgml : 20190429 20190429163651 ACCESSION NUMBER: 0001743936-19-000004 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190425 FILED AS OF DATE: 20190429 DATE AS OF CHANGE: 20190429 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: De Mezerville Roberto CENTRAL INDEX KEY: 0001743936 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38593 FILM NUMBER: 19776444 MAIL ADDRESS: STREET 1: C/O MOTIVA USA LLC STREET 2: 16192 COASTAL HIGHWAY CITY: LEWES STATE: DE ZIP: 19958 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_155657019658456.xml FORM 4 X0306 4 2019-04-25 0 0001688757 ESTABLISHMENT LABS HOLDINGS INC. ESTA 0001743936 De Mezerville Roberto C/O MOTIVA USA LLC 16192 COASTAL HIGHWAY LEWES DE 19958 0 1 0 0 Chief Technology Officer Stock Option (Right to buy) 25.25 2019-04-25 4 A 0 25000 0 A 2029-04-25 Common Shares 25000.0 25000 D One-fourth of the shares subject to the option shall vest on January 1, 2021 and each one-year anniversary thereafter, subject to the Reporting Person continuing as a service provider through each such date. /s/ Renee M. Gaeta, by power of attorney 2019-04-29