SEC Form 4 · accession 0001628280-18-009505
ESTABLISHMENT LABS HOLDINGS INC. · ESTA
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
A later amendment supersedes this filing — read the amendment. The figures below are kept as originally reported (version chain, not an overwrite).
Reporting owner
Quiros Juan Jose Chacon
Officer — Chief Executive Officer · Director
Period of report
Jul 23, 2018
Accepted (ET)
Jul 23, 2018 · 4:25 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001688757
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common SharesF1 | Jul 23, 2018 | C | 237,026 | — | A | 237,026 | D | |
| Common SharesF1,F2 | Jul 23, 2018 | C | 1,128,264 | — | A | 1,128,264 | I | See Footnote |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Class A Ordinary SharesF1 | — | Jul 23, 2018 | C | 237,026 | D | — | — | Common Shares | 237,026 | 0 | D |
| Class A Ordinary SharesF2,F1 | — | Jul 23, 2018 | C | 1,128,264 | D | — | — | Common Shares | 1,128,264 | 0 | I |
Explanation of responses
- F1The Class A Ordinary Shares automatically converted into Common Shares on a one-for-one basis upon the closing of the Issuer's initial public offering of Common Shares and had no expiration date.
- F2The 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.