Sec Form 4 Filing - Coburn Brooke B. @ NESCO HOLDINGS, INC. - 2019-07-30

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Coburn Brooke B.
2. Issuer Name and Ticker or Trading Symbol
NESCO HOLDINGS, INC. [ NSCO]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
C/O CAPITOL INVESTMENT CORP. IV, 1300 17TH STREET, SUITE 820
3. Date of Earliest Transaction (MM/DD/YY)
07/30/2019
(Street)
ARLINGTON, VA20009
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Common Stock ( 1 ) 07/30/2019 C 38,332 A 38,332 D
Common Stock 07/31/2019 A 4,985 A $ 10 43,317 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Class B Ordinary Shares ( 1 ) 07/30/2019 D 11,668 ( 1 ) ( 1 ) Common Stock 11,668 ( 2 ) 38,332 D
Class B Ordinary Shares ( 1 ) 07/30/2019 C 38,332 ( 1 ) ( 1 ) Common Stock 38,332 ( 1 ) 0 D
Warrants $ 11.5 07/30/2019 D 51,020 ( 3 ) ( 4 ) Common Stock 51,020 ( 2 ) 82,313 D
Convertible Promissory Note ( 6 ) $ 1.5 07/31/2019 C ( 5 ) ( 5 ) Warrants 20,408 ( 6 ) $ 0 D
Warrants $ 11.5 07/31/2019 C 20,408 ( 3 ) ( 4 ) Common Stock 20,408 $ 1.5 102,721 D
Warrants $ 11.5 07/31/2019 S 20,408 ( 3 ) ( 4 ) Common Stock 20,408 $ 1.5 82,313 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Coburn Brooke B.
C/O CAPITOL INVESTMENT CORP. IV
1300 17TH STREET, SUITE 820
ARLINGTON, VA20009
X
Signatures
Brooke B. Coburn 08/01/2019
Signature of Reporting Person Date
Explanation of Responses:
( 1 )The Class B Ordinary Shares were convertible on a one-for-one basis into common equity of the surviving entity upon the consummation of the Issuer's initial business combination and had no exiration date. In connection with the Issuer's business combination, such Class B Ordinary Shares of Capitol Investment Corp. IV automatically converted into shares of common stock of Nesco Holdings, Inc.
( 2 )The reporting person forfeited these securities to the Issuer for no additional consideration.
( 3 )The warrants will become exercisable 30 days after the completion of the Issuer's initial business combination.
( 4 )The warrants will expire on the fifth anniversary of the completion of the Issuer's initial business combination.
( 5 )The promissory note is convertible, at the reporting person's option, at the closing of the Issuer's initial business combination. If the note is not converted, it will be repaid within 5 business days of the closing of such business combination.
( 6 )The reporting person was issued a series of convertible promissory notes in consideration of loans made on March 22, 2019, May 15, 2019, and July 24, 2019, in the aggregate principal amount of $30,612.

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* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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