0001104659-15-069985.txt : 20151008
0001104659-15-069985.hdr.sgml : 20151008
20151008172448
ACCESSION NUMBER: 0001104659-15-069985
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20151008
FILED AS OF DATE: 20151008
DATE AS OF CHANGE: 20151008
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: CPI Card Group Inc.
CENTRAL INDEX KEY: 0001641614
STANDARD INDUSTRIAL CLASSIFICATION: SHORT-TERM BUSINESS CREDIT INSTITUTIONS [6153]
IRS NUMBER: 260344657
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 10368 WEST CENTENNIAL ROAD
CITY: LITTLETON
STATE: CO
ZIP: 80127
BUSINESS PHONE: 303-973-9311
MAIL ADDRESS:
STREET 1: 10368 WEST CENTENNIAL ROAD
CITY: LITTLETON
STATE: CO
ZIP: 80127
FORMER COMPANY:
FORMER CONFORMED NAME: CPI Holdings I, Inc.
DATE OF NAME CHANGE: 20150506
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Tricor Pacific Capital Partners (Fund IV) U.S., LP
CENTRAL INDEX KEY: 0001655154
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37584
FILM NUMBER: 151151503
BUSINESS ADDRESS:
STREET 1: C/O TRICOR PACIFIC CAPITAL PARTNERS
STREET 2: ONE WESTMINSTER PLACE SUITE 100
CITY: LAKE FOREST
STATE: CO
ZIP: 60045
BUSINESS PHONE: 847-295-4239
MAIL ADDRESS:
STREET 1: C/O TRICOR PACIFIC CAPITAL PARTNERS
STREET 2: ONE WESTMINSTER PLACE SUITE 100
CITY: LAKE FOREST
STATE: CO
ZIP: 60045
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Tricor Pacific Capital Partners (Fund IV), LP
CENTRAL INDEX KEY: 0001655155
STATE OF INCORPORATION: A1
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37584
FILM NUMBER: 151151504
BUSINESS ADDRESS:
STREET 1: C/O TRICOR PACIFIC CAPITAL PARTNERS
STREET 2: ONE WESTMINSTER PLACE SUITE 100
CITY: LAKE FOREST
STATE: IL
ZIP: 60045
BUSINESS PHONE: 847-295-4239
MAIL ADDRESS:
STREET 1: C/O TRICOR PACIFIC CAPITAL PARTNERS
STREET 2: ONE WESTMINSTER PLACE SUITE 100
CITY: LAKE FOREST
STATE: IL
ZIP: 60045
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Tricor Pacific Capital Partners (Fund IV), ULC
CENTRAL INDEX KEY: 0001655148
STATE OF INCORPORATION: IL
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37584
FILM NUMBER: 151151505
BUSINESS ADDRESS:
STREET 1: ONE WESTMINSTER PLACE
STREET 2: SUITE 100
CITY: LAKE FOREST
STATE: IL
ZIP: 60045
BUSINESS PHONE: 303-973-9311
MAIL ADDRESS:
STREET 1: C/O CPI CARD GROUP INC.
STREET 2: 10368 W. CENTENNIAL RD.
CITY: LITTLETON
STATE: CO
ZIP: 80127
3
1
a3.xml
3
X0206
3
2015-10-08
0
0001641614
CPI Card Group Inc.
PMTS
0001655148
Tricor Pacific Capital Partners (Fund IV), ULC
C/O TRICOR PACIFIC CAPITAL
ONE WESTMINSTER PLACE, SUITE 100
LAKE FOREST
IL
60045
0
0
1
0
0001655155
Tricor Pacific Capital Partners (Fund IV), LP
C/O TRICOR PACIFIC CAPITAL
ONE WESTMINSTER PLACE, SUITE 100
LAKE FOREST
IL
60045
0
0
1
0
0001655154
Tricor Pacific Capital Partners (Fund IV) U.S., LP
C/O TRICOR PACIFIC CAPITAL
ONE WESTMINSTER PLACE, SUITE 100
LAKE FOREST
IL
60045
0
0
1
0
Common Stock
34693736
I
See Footnote
21,816,366 shares reported on this line are held by Tricor Pacific Capital Partners (Fund IV), LP. 12,877,370 shares reported on this line are held by Tricor Pacific Capital Partners (Fund IV) US, LP. Each of Tricor Pacific Capital Partners (Fund IV), LP and Tricor Pacific Capital Partners (Fund IV) US, LP (together, the "Tricor Funds") is managed by Tricor Pacific Capital Partners (Fund IV), ULC, as the general partner. Bradley Seaman, David Rowntree, J. Trevor Johnstone and Roderick Senft are the sole members of an investment committee of the Tricor Funds that has the power to vote or dispose of the shares held by the Tricor Funds. Each member of the investment committee expressly disclaims any beneficial ownership of any shares of common stock held by the Tricor Funds.
Tricor Pacific Capital Partners (Fund IV), ULC By: /s/ Bradley Seaman Name: Bradley Seaman Title: Managing Director
2015-10-08
Tricor Pacific Capital Partners (Fund IV), LP By: Tricor Pacific Capital Partners (Fund IV), ULC, its General Partner By: /s/ Bradley Seaman Name: Bradley Seaman Title: Managing Director
2015-10-08
Tricor Pacific Capital Partners (Fund IV) US, LP By: Tricor Pacific Capital Partners (Fund IV), ULC, its General Partner By: /s/ Bradley Seaman Name: Bradley Seaman Title: Managing Director
2015-10-08