0001104659-15-071443.txt : 20151019 0001104659-15-071443.hdr.sgml : 20151019 20151019202717 ACCESSION NUMBER: 0001104659-15-071443 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20151015 FILED AS OF DATE: 20151019 DATE AS OF CHANGE: 20151019 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37584 FILM NUMBER: 151165286 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37584 FILM NUMBER: 151165287 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37584 FILM NUMBER: 151165288 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 4 1 a4.xml 4 X0306 4 2015-10-15 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 2015-10-15 4 S 0 1899605 9.50 D 32794131 I See footnote 1,194,523 shares reported on this line were sold by Tricor Pacific Capital Partners (Fund IV), LP to the underwriters in the initial public offering of CPI Card Group Inc. (the "Company"). Following such sale, Tricor Pacific Capital Partners (Fund IV), LP holds 20,621,843 shares of common stock of the Company. 705,082 shares reported on this line were sold by Tricor Pacific Capital Partners (Fund IV) US, LP to the underwriters in the initial public offering of the Company. Following such sale, Tricor Pacific Capital Partners (Fund IV) US, LP holds 12,172,288 shares of common stock of the Company. 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 2015-10-19 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 2015-10-19 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 2015-10-19