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