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