0001213900-21-020235.txt : 20210405 0001213900-21-020235.hdr.sgml : 20210405 20210405202022 ACCESSION NUMBER: 0001213900-21-020235 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: Haubenreich Adam P. CENTRAL INDEX KEY: 0001852510 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38186 FILM NUMBER: 21807715 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 0001852510 Haubenreich Adam P. 7701 INDEPENDENCE AVE KANSAS CITY MO 64125 0 1 0 0 VP and General Counsel Common Stock 2021-04-01 4 P 0 45000 5.00 A 45000 D Common Stock 2021-04-01 4 J 0 17318 5.00 A 62318 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 2021-04-05