0000899243-21-016583.txt : 20210421 0000899243-21-016583.hdr.sgml : 20210421 20210421160549 ACCESSION NUMBER: 0000899243-21-016583 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210419 FILED AS OF DATE: 20210421 DATE AS OF CHANGE: 20210421 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Francis Karen C CENTRAL INDEX KEY: 0001607429 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40326 FILM NUMBER: 21841487 MAIL ADDRESS: STREET 1: 200 SW 1ST AVE STREET 2: SUITE 1600 CITY: FORT LAUDERDALE STATE: FL ZIP: 33301 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: TuSimple Holdings Inc. CENTRAL INDEX KEY: 0001823593 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER INTEGRATED SYSTEMS DESIGN [7373] IRS NUMBER: 862341575 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 9191 TOWNE CENTRE DRIVE, SUITE 600 CITY: SAN DIEGO STATE: CA ZIP: 92122 BUSINESS PHONE: (619) 916-3144 MAIL ADDRESS: STREET 1: 9191 TOWNE CENTRE DRIVE, SUITE 600 CITY: SAN DIEGO STATE: CA ZIP: 92122 FORMER COMPANY: FORMER CONFORMED NAME: Tusimple (Cayman) Ltd DATE OF NAME CHANGE: 20200903 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-04-19 0 0001823593 TuSimple Holdings Inc. TSP 0001607429 Francis Karen C 9191 TOWNE CENTRE DRIVE, STE 600 SAN DIEGO CA 92122 1 0 0 0 Common Stock 2021-04-19 4 C 0 20000 A 20000 I By trust Common Stock 2021-04-19 4 C 0 20000 A 20000 I By trust Common Stock 2021-04-19 4 J 0 20000 D 0 I By trust Common Stock 2021-04-19 4 J 0 20000 D 0 I By trust Common Stock 2021-04-19 4 J 0 60000 D 0 D Class A Common Stock 2021-04-19 4 J 0 20000 A 20000 I By trust Class A Common Stock 2021-04-19 4 J 0 20000 A 20000 I By trust Class A Common Stock 2021-04-19 4 J 0 60000 A 60000 D Class A Common Stock 2021-04-19 4 P 0 7142 40.00 A 67142 D Series E Convertible Preferred Stock 2021-04-19 4 C 0 20000 D Class A Common Stock 20000 0 I By trust Series E Convertible Preferred Stock 2021-04-19 4 C 0 20000 D Class A Common Stock 20000 0 I By trust The total represents shares received upon conversion of shares of Series E Convertible Preferred Stock. The reported security converted into the Issuer's Common Stock on a one-for-one basis automatically immediately prior to the closing of the issuer's initial public offering without payment of further consideration. The shares have no expiration date. The shares are held by the Karen C. Francis Second Restated Revocable Trust dated 1.30.2012, of which the Reporting Person is trustee. The shares are held by the Richard C. DeGolia Trust dated 8.27.2004, of which the Reporting Person's spouse is trustee. Pursuant to a reclassification exempt under Rule 16b-7, each share of Common Stock was automatically reclassified into one share of Class A Common Stock immediately prior to the completion of the Issuer's initial public offering of Class A Common Stock. The shares are subject to the issuer's right of repurchase, which shall lapse over a three-year period in equal quarterly installments after December 15, 2020, subject to the Reporting Person's continuous service with the issuer. Represents shares purchased in the Issuer's initial public offering. /s/ James Mullen - Attorney-in-Fact 2021-04-21