- Initial Statement of Beneficial Ownership (3)
May 07 2012 - 3:45PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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hours per response...
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
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DIAMOND CASTLE PARTNERS IV L P
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2. Date of Event Requiring Statement (MM/DD/YYYY)
5/7/2012
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3. Issuer Name
and
Ticker or Trading Symbol
Community Choice Financial Inc. [CCFI]
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(Last)
(First)
(Middle)
C/O DIAMOND CASTLE HOLDINGS, LLC 280 PARK AVE, FLOOR 25E
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
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X
___ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Street)
NEW YORK, NY 10017
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
___ Form filed by One Reporting Person
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X
_ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Shares
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3451056
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D
(1)
(5)
(6)
(7)
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Common Shares
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1308600
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D
(2)
(4)
(6)
(7)
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Common Shares
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46344
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D
(3)
(4)
(5)
(7)
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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(
1)
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Shares held directly by Diamond Castle Partners IV L.P., or DCP IV, of which DCP IV GP L.P. is the general partner (DCP IV GP-GP, L.L.C. is the general partner of DCP IV GP, L.P.).
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(
2)
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Shares held directly by Diamond Castle Partners IV-A, L.P., or DCP IV-A, of which DCP IV GP L.P. is the general partner (DCP IV GP-GP, L.L.C. is the general partner of DCP IV GP, L.P.).
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(
3)
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Shares held directly by Deal Leaders Fund, L.P., or DLF, of which DCP IV GP L.P. is the general partner (DCP IV GP-GP, L.L.C. is the general partner of DCP IV GP, L.P.).
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(
4)
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Diamond Castle Partners IV, L.P. disclaims beneficial ownership of these securities and this report shall not be deemed to be an admission that it is the beneficial owner of such securities for purposes of Section 16 or for any other purpose.
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(
5)
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Diamond Castle Partners IV-A, L.P. disclaims beneficial ownership of these securities and this report shall not be deemed to be an admission that it is the beneficial owner of such securities for purposes of Section 16 or for any other purpose.
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(
6)
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Deal Leaders Fund, L.P. disclaims beneficial ownership of these securities and this report shall not be deemed to be an admission that it is the beneficial owner of such securities for purposes of Section 16 or for any other purpose.
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(
7)
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The manner in which the investments of DCP IV, DCP IV-A and DLF are held, and any decisions concerning their ultimate disposition, are subject to the control of an investment committee consisting of certain partners of Diamond Castle: Ari Benacerraf, Michael Ranger, Andrew Rush, and David Wittels. The investment committee is appointed by DCP IV GP, L.P. The investment committee has voting and investment power with respect to the common shares owned by DCP IV, DCP IV-A, and DLF. Andrew Rush and David Wittels are directors of this Issuer, and this Form 3 should be read together with the Form 3s filed simultaneously for Messrs. Rush and Wittels.
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Remarks:
(a) Diamond Castle Partners IV, L.P., By: DCP IV GP, L.P., its General Partner; By: DCP IV GP-GP, LLC, its General Partner; By: /s/ Bridgette Roman as attorney-in-fact (b) Diamond Castle Partners IV-A, L.P., By: DCP IV GP, L.P., its General Partner; By: DCP IV GP-GP, LLC, its General Partner; By: /s/ Bridgette Roman as attorney-in-fact (c) Deal Leaders Fund, L.P., By: DCP IV GP, L.P., its General Partner; By: DCP IV GP-GP, LLC, its General Partner; By: /s/ Bridgette Roman as attorney-in-fact
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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DIAMOND CASTLE PARTNERS IV L P
C/O DIAMOND CASTLE HOLDINGS
LLC 280 PARK AVE, FLOOR 25E
NEW YORK, NY 10017
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X
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DIAMOND CASTLE PARTNERS IV-A L P
C/O DIAMOND CASTLE HOLDINGS
LLC 280 PARK AVE, FLOOR 25E
NEW YORK, NY 10017
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X
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DEAL LEADERS FUND L P
C/O DIAMOND CASTLE HOLDINGS
LLC 280 PARK AVE, FLOOR 25E
NEW YORK, NY 10017
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X
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DCP IV GP, L.P.
C/O DIAMOND CASTLE HOLDINGS
LLC 280 PARK AVE, FLOOR 25E
NEW YORK, NY 10017
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X
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DCP IV GP-GP, LLC
C/O DIAMOND CASTLE HOLDINGS
LLC 280 PARK AVE, FLOOR 25E
NEW YORK, NY 10017
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X
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BENACERRAF ARI J
C/O DIAMOND CASTLE HOLDINGS
LLC 280 PARK AVE, FLOOR 25E
NEW YORK, NY 10017
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X
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RANGER MICHAEL W
C/O DIAMOND CASTLE HOLDINGS
LLC 280 PARK AVE, FLOOR 25E
NEW YORK, NY 10017
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X
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Signatures
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Diamond Castle Partners IV, L.P., By: DCP IV GP, L.P., its General Partner; By: DCP IV GP-GP, LLC, its General Partner; By: /s/ Bridgette Roman as attorney-in-fact
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5/7/2012
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**
Signature of Reporting Person
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Date
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Diamond Castle Partners IV-A, L.P., By: DCP IV GP, L.P., its General Partner; By: DCP IV GP-GP, LLC, its General Partner; By: /s/ Bridgette Roman as attorney-in-fact
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5/7/2012
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**
Signature of Reporting Person
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Date
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Deal Leaders Fund, L.P., By: DCP IV GP, L.P., its General Partner; By: DCP IV GP-GP, LLC, its General Partner; By: /s/ Bridgette Roman as attorney-in-fact
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5/7/2012
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**
Signature of Reporting Person
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Date
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DCP IV GP, L.P.; By: DCP IV GP-GP, LLC, its General Partner; By: /s/ Bridgette Roman as attorney-in-fact
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5/7/2012
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**
Signature of Reporting Person
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Date
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DCP IV GP-GP, LLC; By: /s/ Bridgette Roman as attorney-in-fact
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5/7/2012
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Signature of Reporting Person
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Date
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Ari J. Benacerraf; By: /s/ Bridgette Roman as attorney-in-fact
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5/7/2012
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Signature of Reporting Person
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Date
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Michael W. Ranger; By: /s/ Bridgette Roman as attorney-in-fact
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5/7/2012
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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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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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 control number.
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