0001743936-20-000002.txt : 20200513 0001743936-20-000002.hdr.sgml : 20200513 20200513163535 ACCESSION NUMBER: 0001743936-20-000002 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200513 FILED AS OF DATE: 20200513 DATE AS OF CHANGE: 20200513 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: 20873663 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_158940211752668.xml FORM 4 X0306 4 2020-05-13 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 Common Shares 2020-05-13 4 P 0 10 17.13 A 152844 D Stock Option (Right to buy) 25.25 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 2020-05-13