0001213900-21-020243.txt : 20210405
0001213900-21-020243.hdr.sgml : 20210405
20210405202339
ACCESSION NUMBER: 0001213900-21-020243
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210401
FILED AS OF DATE: 20210405
DATE AS OF CHANGE: 20210405
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Carlsen James
CENTRAL INDEX KEY: 0001854934
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38186
FILM NUMBER: 21807724
MAIL ADDRESS:
STREET 1: C/O NESCO HOLDINGS, INC.
STREET 2: 6714 POINTE INVERNESS WAY, SUITE 220
CITY: FORT WAYNE
STATE: IN
ZIP: 46804
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Custom Truck One Source, Inc.
CENTRAL INDEX KEY: 0001709682
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-EQUIPMENT RENTAL & LEASING, NEC [7359]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 7701 INDEPENDENCE AVENUE
CITY: KANSAS CITY
STATE: MO
ZIP: 64125
BUSINESS PHONE: (816) 241-4888
MAIL ADDRESS:
STREET 1: 7701 INDEPENDENCE AVENUE
CITY: KANSAS CITY
STATE: MO
ZIP: 64125
FORMER COMPANY:
FORMER CONFORMED NAME: NESCO HOLDINGS, INC.
DATE OF NAME CHANGE: 20190730
FORMER COMPANY:
FORMER CONFORMED NAME: Capitol Investment Corp. IV
DATE OF NAME CHANGE: 20170619
4
1
ownership.xml
X0306
4
2021-04-01
0
0001709682
Custom Truck One Source, Inc.
CTOS
0001854934
Carlsen James
7701 INDEPENDENCE AVE
KANSAS CITY
MO
64125
0
1
0
0
EVP - Rentals
Common Stock
2021-04-01
4
P
0
20000
5.00
A
20000
D
Common Stock
2021-04-01
4
J
0
11974
5.00
A
31974
D
In connection with the acquisition of Custom Truck One Source, L.P. ("Custom Truck") by the Issuer, the reporting person received shares of the Issuer's Common Stock in exchange for a portion of their Custom Truck equity interests with a value equal to the product of (x) $5.00 multiplied by (y) the number of shares of Common Stock received.
/s/ Adam Haubenreich, Attorney-in-fact
2021-04-05