0001104659-17-059298.txt : 20170927 0001104659-17-059298.hdr.sgml : 20170927 20170927214203 ACCESSION NUMBER: 0001104659-17-059298 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170925 FILED AS OF DATE: 20170927 DATE AS OF CHANGE: 20170927 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Rossetti Anna CENTRAL INDEX KEY: 0001654518 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37584 FILM NUMBER: 171105435 MAIL ADDRESS: STREET 1: 10368 WEST CENTENNIAL RD. CITY: LITTLETON STATE: CO 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 2017-09-25 0 0001641614 CPI Card Group Inc. PMTS 0001654518 Rossetti Anna C/O CPI CARD GROUP INC. 10026 WEST SAN JUAN WAY LITTLETON CO 80127 0 1 0 0 President-CPI Canada Stock Option (Right to Buy) 1.05 2017-09-25 4 A 0 125000 0 A 2018-09-25 2027-09-25 Common Stock 125000 125000 D The grant of 55,310 options is contingent upon receipt and effectiveness of approval by the Company's stockholders of an amendment to the CPI Card Group Inc. Omnibus Incentive Plan to, among other things, increase the number of shares available for issuance thereunder. Date at which first vesting occurs is indicated. One-third (1/3) of the original options awarded will vest on each of the first, second and third anniversaries of the September 25, 2017 award date. /s/Lisa Jacoba, by Power of Attorney 2017-09-27