0001757346-21-000003.txt : 20210526
0001757346-21-000003.hdr.sgml : 20210526
20210526162710
ACCESSION NUMBER: 0001757346-21-000003
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210524
FILED AS OF DATE: 20210526
DATE AS OF CHANGE: 20210526
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Dastidar Pratip
CENTRAL INDEX KEY: 0001757346
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38593
FILM NUMBER: 21966616
MAIL ADDRESS:
STREET 1: 150 PEABODY PLACE
CITY: MEMPHIS
STATE: TN
ZIP: 38103
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_162206081018208.xml
FORM 4
X0306
4
2021-05-24
0
0001688757
ESTABLISHMENT LABS HOLDINGS INC.
ESTA
0001757346
Dastidar Pratip
C/O MOTIVA USA LLC
16192 COASTAL HIGHWAY
LEWES
DE
19958
0
1
0
0
Head of Global Operations
Stock Option (Right to buy)
77.11
2021-05-24
4
A
0
50000
0
A
2031-05-24
Common Shares
50000.0
50000
D
One-fourth of the shares subject to the option shall vest on May 17, 2022 and each one-year anniversary thereafter, subject to the Reporting Person continuing as a service provider through each such date.
Renee Gaeta, by power of attorney
2021-05-26