0001958530-22-000003.txt : 20221223 0001958530-22-000003.hdr.sgml : 20221223 20221223100713 ACCESSION NUMBER: 0001958530-22-000003 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: 20221223 DATE AS OF CHANGE: 20221223 EFFECTIVENESS DATE: 20221223 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Clayton, Dubilier & Rice Fund XII-A, L.P. CENTRAL INDEX KEY: 0001958530 IRS NUMBER: 000000000 STATE OF INCORPORATION: E9 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-468568 FILM NUMBER: 221483707 BUSINESS ADDRESS: STREET 1: 375 PARK AVENUE CITY: NEW YORK STATE: NY ZIP: 10152 BUSINESS PHONE: 212-407-5200 MAIL ADDRESS: STREET 1: 375 PARK AVENUE CITY: NEW YORK STATE: NY ZIP: 10152 D 1 primary_doc.xml X0708 D LIVE 0001958530 Clayton, Dubilier & Rice Fund XII-A, L.P. 375 PARK AVENUE NEW YORK NY NEW YORK 10152 212-407-5200 CAYMAN ISLANDS None None Other a Cayman Islands exempted limited partnership true 2022 - CD&R Associates XII, L.P. MAPLES CORPORATE SERVICES LIMITED UGLAND HOUSE GRAND CAYMAN E9 CAYMAN ISLANDS KY1-1104 Promoter - CD&R Investment Associates XII, Ltd. MAPLES CORPORATE SERVICES LIMITED UGLAND HOUSE GRAND CAYMAN E9 CAYMAN ISLANDS KY1-1104 Promoter General partner of the general partner Donald J. Gogel c/o Clayton, Dubilier & Rice, LLC 375 Park Avenue New York NY NEW YORK 10152 Executive Officer Executive officer of the general partner of the general partner Jillian C. Griffiths c/o Clayton, Dubilier & Rice, LLC 375 Park Avenue New York NY NEW YORK 10152 Executive Officer Executive officer of the general partner of the general partner David A. Novak c/o Clayton, Dubilier & Rice, LLC 375 Park Avenue New York NY NEW YORK 10152 Executive Officer Executive officer of the general partner of the general partner Richard J. Schnall c/o Clayton, Dubilier & Rice, LLC 375 Park Avenue New York NY NEW YORK 10152 Executive Officer Executive officer of the general partner of the general partner Rima Simson c/o Clayton, Dubilier & Rice, LLC 375 Park Avenue New York NY NEW YORK 10152 Executive Officer Executive officer of the general partner of the general partner Nathan K. Sleeper c/o Clayton, Dubilier & Rice, LLC 375 Park Avenue New York NY NEW YORK 10152 Executive Officer Executive officer of the general partner of the general partner 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 XII-A, L.P. /s/ Rima Simson Rima Simson Vice President, Treasurer & Secretary of GP of GP of Issuer 2022-12-20