0001944800-23-000001.txt : 20230308 0001944800-23-000001.hdr.sgml : 20230308 20230308170252 ACCESSION NUMBER: 0001944800-23-000001 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230306 FILED AS OF DATE: 20230308 DATE AS OF CHANGE: 20230308 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: 23716883 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_167831295728878.xml FORM 4 X0306 4 2023-03-06 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 Compliance Officer Common Shares 2023-03-06 4 A 0 2860 0 A 2860 D Stock Option (Right to buy) 74.47 2023-03-06 4 A 0 6933 0 A 2033-03-06 Common Shares 6933.0 6933 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, 2024 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, 2024 and each one-year anniversary thereafter, subject to the Reporting Person continuing as a service provider through such date. /s/ Rajbir S. Denhoy, by power of attorney 2023-03-08