0001944800-24-000005.txt : 20240319
0001944800-24-000005.hdr.sgml : 20240319
20240319175741
ACCESSION NUMBER: 0001944800-24-000005
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20240306
FILED AS OF DATE: 20240319
DATE AS OF CHANGE: 20240319
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Mansbach Samuel Ross
CENTRAL INDEX KEY: 0001944800
ORGANIZATION NAME:
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38593
FILM NUMBER: 24765322
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]
ORGANIZATION NAME: 08 Industrial Applications and Services
IRS NUMBER: 981436377
STATE OF INCORPORATION: D8
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: BUILDING B15 AND 25 COYOL FREE ZONE
CITY: ALAJUELA
STATE: G2
ZIP: 20101
BUSINESS PHONE: 50624342400
MAIL ADDRESS:
STREET 1: BUILDING B15 AND 25 COYOL FREE ZONE
CITY: ALAJUELA
STATE: G2
ZIP: 20101
4
1
wk-form4_1710885439.xml
FORM 4
X0508
4
2024-03-06
0
0001688757
ESTABLISHMENT LABS HOLDINGS INC.
ESTA
0001944800
Mansbach Samuel Ross
C/O MOTIVA USA LLC
16192 COASTAL HIGHWAY
LEWES
DE
19958
0
0
0
1
GC & Chief HR Officer
0
Common Shares
2024-03-06
4
A
0
5406
0
A
10812
D
Stock Option (Right to buy)
49.25
2024-03-06
4
A
0
7691
0
A
2034-03-06
Common Shares
7691
7691
D
Represents an award of stock units under the Issuer's 2018 Equity Incentive Plan. One-fourth of the shares subject to the award shall vest on March 6, 2025 and each one-year anniversary thereafter, subject to the Reporting Person continuing as a service provider through such date.
One-fourth of the shares subject to the option shall vest on March 6, 2025 and each one-year anniversary thereafter, subject to the Reporting Person continuing as a service provider through such date.
/s/ Rajbir S. Denhoy, Chief Financial Officer, by power of attorney
2024-03-19