0001398327-23-000004.txt : 20230531
0001398327-23-000004.hdr.sgml : 20230531
20230531161912
ACCESSION NUMBER: 0001398327-23-000004
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230528
FILED AS OF DATE: 20230531
DATE AS OF CHANGE: 20230531
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: LEWIN NICHOLAS SHERIDAN
CENTRAL INDEX KEY: 0001398327
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38593
FILM NUMBER: 23981254
MAIL ADDRESS:
STREET 1: 3 WEST 57TH ST.
STREET 2: 8TH FLOOR
CITY: NEW YORK
STATE: NY
ZIP: 10019
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
FISCAL YEAR END: 1231
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
wk-form4_1685564336.xml
FORM 4
X0407
4
2023-05-28
0
0001688757
ESTABLISHMENT LABS HOLDINGS INC.
ESTA
0001398327
LEWIN NICHOLAS SHERIDAN
C/O MOTIVA USA LLC
16192 COASTAL HIGHWAY
LEWES
DE
19958
1
0
0
0
0
Common Shares
2023-05-28
4
A
0
27756
0
A
812888
D
Common Shares
8790
I
See Footnote
Represents an award of stock units under the Issuer's 2018 Equity Incentive Plan. One-third of the shares subject to the award shall vest on May 24, 2024 and each 1-year anniversary thereafter, subject to the Reporting Person continuing as Chairman of the Board through such date, and will be payable subject to meeting specified stock price hurdles, as follows: (i) 100% of the time-based vested shares subject to the award will be payable if the closing price of a common share of the Company equals 150% of the grant date closing price, and (ii) 200% of the time-based vested shares subject to the award will be payable if the closing price of a common share of the Company equals or exceeds 200% of the grant date closing price, in each case for 20 consecutive trading days at any time during a 5-year performance period ending May 24, 2028. The payout percentage between these levels will be determined by linear interpolation.
The shares are held by the Reporting Person's spouse.
/s/ Rajbir S. Denhoy, by power of attorney
2023-05-31