0001742429-24-000004.txt : 20240319
0001742429-24-000004.hdr.sgml : 20240319
20240319175522
ACCESSION NUMBER: 0001742429-24-000004
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: Chacon Quiros Juan Jose
CENTRAL INDEX KEY: 0001742429
ORGANIZATION NAME:
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38593
FILM NUMBER: 24765310
MAIL ADDRESS:
STREET 1: C/O MOTIVA USA LLC
STREET 2: 16192 COASTAL HIGHWAY
CITY: LEWES
STATE: DE
ZIP: 19958
FORMER NAME:
FORMER CONFORMED NAME: Quiros Juan Jose Chacon
DATE OF NAME CHANGE: 20180601
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_1710885312.xml
FORM 4
X0508
4
2024-03-06
0
0001688757
ESTABLISHMENT LABS HOLDINGS INC.
ESTA
0001742429
Chacon Quiros Juan Jose
C/O MOTIVA USA LLC
16192 COASTAL HIGHWAY
LEWES
DE
19958
1
1
0
0
Chief Executive Officer
0
Common Shares
2024-03-06
4
A
0
13519
0
A
225735
D
Common Shares
1128264
I
See Footnote
Stock Option (Right to buy)
49.25
2024-03-06
4
A
0
19236
0
A
2034-03-06
Common Shares
19236
19236
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.
The shares are held by Sariel LLC. The Reporting Person is a shareholder of Sariel LLC and has voting and dispositive power over the shares owned by Sariel LLC. The Reporting Person disclaims beneficial ownership of the shares held by Sariel LLC, except to the extent of his pecuniary interest therein.
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 each such date.
/s/ Rajbir S. Denhoy, Chief Financial Officer, by power of attorney
2024-03-19