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