0001944800-24-000006.txt : 20240405 0001944800-24-000006.hdr.sgml : 20240405 20240405161047 ACCESSION NUMBER: 0001944800-24-000006 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240306 FILED AS OF DATE: 20240405 DATE AS OF CHANGE: 20240405 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Mansbach Samuel Ross CENTRAL INDEX KEY: 0001944800 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-38593 FILM NUMBER: 24826609 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/A 1 wk-form4a_1712347834.xml FORM 4/A X0508 4/A 2024-03-06 2024-03-19 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 HR Officer 0 Common Shares 2024-03-06 4 A 0 5406 0 A 8014 D Stock Option (Right to buy) 49.25 2024-03-06 4 A 0 7691 0 A 2034-03-06 Common Shares 7691 7691 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. 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 such date. /s/ Rajbir S. Denhoy, Chief Financial Officer, by power of attorney 2024-04-05