SEC Form 3
FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 11/10/2022 |
3. Issuer Name and Ticker or Trading Symbol
TuSimple Holdings Inc. [ TSP ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Class A Common Stock | 1,719,578 | D | |
Class A Common Stock | 900,000 | I | By LLC(1) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Stock Option (right to buy) | (2) | 11/10/2024 | Common Stock | 500,000 | 4.2 | D | |
Stock Option (right to buy) | (3) | 11/10/2024 | Common Stock | 100,000 | 8.11 | D | |
Stock Option (right to buy) | (4) | 11/10/2024 | Common Stock | 100,000 | 14 | D | |
Stock Option (right to buy) | (5) | 11/10/2024 | Common Stock | 1,150,000 | 14.1401 | D |
Explanation of Responses: |
1. The shares are held by Hickory Wood Grove LLC, a limited liability company incorporated in Delaware and deemed beneficially owned by the Reporting Person. |
2. The options are subject to a service-based vesting requirement, which shall be satisfied over a three-year period. 30% of the options vest on December 31, 2021 and 8.75% of the options shall vest each quarter thereafter, except that all unvested options as of March 3, 2023 will accelerate and be fully vest on such date. |
3. The options are subject to a service-based vesting requirement, which shall be satisfied over a three-year period. 30% of the options vest on December 31, 2021 and 8.75% of the options shall vest each quarter thereafter, except that all unvested options as of March 3, 2023 will accelerate and be fully vest on such date. |
4. The options are subject to a service-based vesting requirement, which shall be satisfied over a three-year period. 30% of the options vest on December 31, 2021 and 8.75% of the options shall vest each quarter thereafter, except that all unvested options as of March 3, 2023 will accelerate and be fully vest on such date. |
5. The options are subject to a service-based vesting requirement, which shall be satisfied over a five-year period with 5% of the options vesting each quarter after December 31, 2020, except that all unvested options as of March 3, 2023 will accelerate and fully vest on such date. |
Remarks: |
Exhibit 24 - Power of Attorney |
/s/ Evan Dunn, Attorney-in-Fact | 11/21/2022 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |