0001944800-22-000004.txt : 20220831 0001944800-22-000004.hdr.sgml : 20220831 20220831161758 ACCESSION NUMBER: 0001944800-22-000004 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220829 FILED AS OF DATE: 20220831 DATE AS OF CHANGE: 20220831 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Mansbach Samuel Ross CENTRAL INDEX KEY: 0001944800 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38593 FILM NUMBER: 221218160 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] 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_166197706198522.xml FORM 4 X0306 4 2022-08-29 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 Compliance Officer Stock Option (Right to buy) 63.55 2022-08-29 4 A 0 34796 0 A 2032-08-29 Common Shares 34796.0 34796 D One-fourth of the shares subject to the option shall vest on August 29, 2022 and each one-year anniversary thereafter, subject to the Reporting Person continuing as a service provider through each such date. /s/ Rajbir S. Denhoy, by power of attorney 2022-08-31