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*
O'Leary Margaret Elizabeth

(Last) (First) (Middle)
C/O CPI CARD GROUP INC.
10368 WEST CENTENNIAL ROAD

(Street)
LITTLETON CO 80127

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
12/13/2022
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 10% Owner
X Officer (give title below) Other (specify below)
SVP, Prepaid Solutions
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
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 7,877 D
Common Stock 500 I By Spouse
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
Restricted Stock Units (1) (1) Common Stock 694 (2) D
Stock Option (Right to Buy) (3) 10/08/2025 Common Stock 1,400 $50 D
Stock Option (Right to Buy) (3) 03/22/2027 Common Stock 1,320 $21.75 D
Stock Option (Right to Buy) (4) 09/21/2028 Common Stock 2,354 $29.62 D
Explanation of Responses:
1. The restricted stock units ("RSUs") reported on this line will vest on the second anniversary of the September 21, 2021 award date, subject to the reporting person's continued service through such date or as otherwise provided for in the applicable award agreement.
2. Each RSU represents the right to receive one common share of Issuer upon vesting of such RSU.
3. Options fully vested and exercisable.
4. 50% of the options reported on this line vested on the first anniversary of the September 21, 2021 award date, and 50% vest on the second anniversary of the award date, subject to the reporting person's continued service through such date or as otherwise provided for in the applicable award agreement.
Remarks:
Exhibit 24 - Power of Attorney
/s/ Sarah Kilgore as attorney-in-fact 12/23/2022
** 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.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.