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*
Tricor Pacific Capital Partners (Fund IV), ULC

(Last) (First) (Middle)
C/O TRICOR PACIFIC CAPITAL
ONE WESTMINSTER PLACE, SUITE 100

(Street)
LAKE FOREST IL 60045

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/08/2015
3. Issuer Name and Ticker or Trading Symbol
CPI Card Group Inc. [ PMTS ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
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)
Common Stock 34,693,736(1) I See Footnote(1)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
1. Name and Address of Reporting Person*
Tricor Pacific Capital Partners (Fund IV), ULC

(Last) (First) (Middle)
C/O TRICOR PACIFIC CAPITAL
ONE WESTMINSTER PLACE, SUITE 100

(Street)
LAKE FOREST IL 60045

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
Tricor Pacific Capital Partners (Fund IV), LP

(Last) (First) (Middle)
C/O TRICOR PACIFIC CAPITAL
ONE WESTMINSTER PLACE, SUITE 100

(Street)
LAKE FOREST IL 60045

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
Tricor Pacific Capital Partners (Fund IV) U.S., LP

(Last) (First) (Middle)
C/O TRICOR PACIFIC CAPITAL
ONE WESTMINSTER PLACE, SUITE 100

(Street)
LAKE FOREST IL 60045

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
Explanation of Responses:
1. 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 10/08/2015
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 10/08/2015
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 10/08/2015
** 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.
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