0001691978-16-000002.txt : 20161223 0001691978-16-000002.hdr.sgml : 20161223 20161223153223 ACCESSION NUMBER: 0001691978-16-000002 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b ITEM INFORMATION: Investment Company Act Section 3(c) ITEM INFORMATION: Section 3(c)(7) FILED AS OF DATE: 20161223 DATE AS OF CHANGE: 20161223 EFFECTIVENESS DATE: 20161223 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Clayton, Dubilier & Rice Fund X-A, L.P. CENTRAL INDEX KEY: 0001691978 IRS NUMBER: 000000000 STATE OF INCORPORATION: E9 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-277008 FILM NUMBER: 162068981 BUSINESS ADDRESS: STREET 1: MAPLES CORPORATE SERVICES LIMITED STREET 2: UGLAND HOUSE CITY: GRAND CAYMAN STATE: E9 ZIP: KY1-1104 BUSINESS PHONE: (345) 949-8066 MAIL ADDRESS: STREET 1: MAPLES CORPORATE SERVICES LIMITED STREET 2: UGLAND HOUSE CITY: GRAND CAYMAN STATE: E9 ZIP: KY1-1104 D 1 primary_doc.xml X0707 D LIVE 0001691978 Clayton, Dubilier & Rice Fund X-A, L.P. MAPLES CORPORATE SERVICES LIMITED UGLAND HOUSE GRAND CAYMAN E9 CAYMAN ISLANDS KY1-1104 (345) 949-8066 CAYMAN ISLANDS None None Limited Partnership true 2016 Kevin J. Conway Clayton, Dubilier & Rice, LLC 375 Park Avenue, 18th Floor New York NY NEW YORK 10152 Executive Officer Executive officer of the general partner of the general partner Donald J. Gogel Clayton, Dubilier & Rice, LLC 375 Park Avenue, 18th Floor New York NY NEW YORK 10152 Executive Officer Executive officer of the general partner of the general partner Theresa A. Gore Clayton, Dubilier & Rice, LLC 375 Park Avenue, 18th Floor New York NY NEW YORK 10152 Executive Officer Executive officer of the general partner of the general partner David A. Novak Clayton, Dubilier & Rice, LLC 375 Park Avenue, 18th Floor New York NY NEW YORK 10152 Executive Officer Executive officer of the general partner of the general partner Richard J. Schnall Clayton, Dubilier & Rice, LLC 375 Park Avenue, 18th Floor New York NY NEW YORK 10152 Executive Officer Executive officer of the general partner of the general partner Nathan K. Sleeper Clayton, Dubilier & Rice, LLC 375 Park Avenue, 18th Floor New York NY NEW YORK 10152 Executive Officer Executive officer of the general partner of the general partner David H. Wasserman Clayton, Dubilier & Rice, LLC 375 Park Avenue, 18th Floor New York NY NEW YORK 10152 Executive Officer Executive officer of the general partner of the general partner None CD&R Associates X, L.P. MAPLES CORPORATE SERVICES LIMITED UGLAND HOUSE GRAND CAYMAN E9 CAYMAN ISLANDS KY1-1104 Promoter Pooled Investment Fund Private Equity Fund false Decline to Disclose 06b 3C 3C.7 false true false true true false 0 Indefinite 0 Indefinite false 0 0 0 0 true false Clayton, Dubilier & Rice Fund X-A, L.P. /s/ Theresa A. Gore Theresa A. Gore Vice President, Treasurer & Assistant Secretary of GP of GP 2016-12-23