0001682628-16-000001.txt : 20160909 0001682628-16-000001.hdr.sgml : 20160909 20160909093114 ACCESSION NUMBER: 0001682628-16-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b ITEM INFORMATION: Investment Company Act Section 3(c) ITEM INFORMATION: Section 3(c)(1) FILED AS OF DATE: 20160909 DATE AS OF CHANGE: 20160909 EFFECTIVENESS DATE: 20160909 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Pacific Lake Partners 2016 CCLP, L.P. CENTRAL INDEX KEY: 0001682628 IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-270355 FILM NUMBER: 161877904 BUSINESS ADDRESS: STREET 1: 800 BOYLSTON STREET, #2200 CITY: BOSTON STATE: MA ZIP: 02199 BUSINESS PHONE: 617-658-3024 MAIL ADDRESS: STREET 1: 800 BOYLSTON STREET, #2200 CITY: BOSTON STATE: MA ZIP: 02199 D 1 primary_doc.xml X0707 D LIVE 0001682628 Pacific Lake Partners 2016 CCLP, L.P. 800 BOYLSTON STREET SUITE 2200 BOSTON MA MASSACHUSETTS 02199 617-658-3024 DELAWARE None None Limited Partnership true 2016 N/A Pacific Lake Partners Equity III, L.L.C. 800 Boylston Street Suite 2200 Boston MA MASSACHUSETTS 02199 Executive Officer General Partner of the Issuer (the "General Partner") Thomas Coleman Andrews IV 800 Boylston Street Suite 2200 Boston MA MASSACHUSETTS 02199 Executive Officer Managing Member of the General Partner N/A Pacific Lake Partners, L.L.C. 800 Boylston Street Suite 2200 Boston MA MASSACHUSETTS 02199 Executive Officer Managing Member of the General Partner Pooled Investment Fund Private Equity Fund false Not Applicable 06b 3C 3C.1 false 2016-09-06 false true false 0 8250000 8250000 0 false 0 0 0 0 false Pacific Lake Partners 2016 CCLP, L.P. /s/ T. Coleman Andrews IV T. Coleman Andrews IV Managing Member of the General Partner 2016-09-09