0001944800-24-000004.txt : 20240307 0001944800-24-000004.hdr.sgml : 20240307 20240307162518 ACCESSION NUMBER: 0001944800-24-000004 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240306 FILED AS OF DATE: 20240307 DATE AS OF CHANGE: 20240307 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Mansbach Samuel Ross CENTRAL INDEX KEY: 0001944800 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38593 FILM NUMBER: 24730500 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] 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_1709846705.xml FORM 4 X0508 4 2024-03-06 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 0 Common Shares 2024-03-06 4 F 0 252 49.25 D 2608 D Represents shares withheld by the Issuer to satisfy tax withholding obligations in connection with the vesting of restricted stock units previously granted to the reporting person. /s/ Rajbir S. Denhoy, Chief Financial Officer, by power of attorney 2024-03-07