0001104659-17-055796.txt : 20170906 0001104659-17-055796.hdr.sgml : 20170906 20170906160959 ACCESSION NUMBER: 0001104659-17-055796 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170901 FILED AS OF DATE: 20170906 DATE AS OF CHANGE: 20170906 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Dubin Lane CENTRAL INDEX KEY: 0001683495 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37584 FILM NUMBER: 171071417 MAIL ADDRESS: STREET 1: C/O CPI CARD GROUP INC. STREET 2: 10368 WEST CENTENNIAL RD. CITY: LITTLETON STATE: IL ZIP: 80127 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: 10026 WEST SAN JUAN WAY CITY: LITTLETON STATE: CO ZIP: 80127 BUSINESS PHONE: 303-973-9311 MAIL ADDRESS: STREET 1: 10026 WEST SAN JUAN WAY CITY: LITTLETON STATE: CO ZIP: 80127 FORMER COMPANY: FORMER CONFORMED NAME: CPI Holdings I, Inc. DATE OF NAME CHANGE: 20150506 4 1 a4.xml 4 X0306 4 2017-09-01 0 0001641614 CPI Card Group Inc. PMTS 0001683495 Dubin Lane C/O CPI CARD GROUP INC. 10026 WEST SAN JUAN WAY LITTLETON CO 80127 0 1 0 0 SVP, Sales & Marketing Common Stock 2017-09-01 4 M 0 4641 A 4641 D Common Stock 2017-09-01 4 F 0 1462 0.96 D 3179 D Restricted Stock Units 2017-09-01 4 M 0 4641 0 D Common Stock 4641 23073 D Each restricted stock unit represents the right to receive one CPI Card Group Inc. common share upon vesting of such restricted stock unit. Shares withheld by the issuer to satisfy the mandatory tax withholding requirement upon vesting of restricted stock. This is not an open market sale of securities. On September 1, 2016, the reporting person was granted 18,562 restricted stock units, vesting in four equal installments on the first, second, third and fourth anniversaries of the award date. Total includes additional restricted stock unit awards that have different vesting and expiration dates. /s/Lisa Jacoba, by Power of Attorney 2017-09-06