0001992569-23-000001.txt : 20231207 0001992569-23-000001.hdr.sgml : 20231207 20231207155128 ACCESSION NUMBER: 0001992569-23-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20231207 DATE AS OF CHANGE: 20231207 EFFECTIVENESS DATE: 20231207 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Prime Special Risk Holding Company, LLC CENTRAL INDEX KEY: 0001992569 IRS NUMBER: 932613164 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-499077 FILM NUMBER: 231472288 BUSINESS ADDRESS: STREET 1: 8722 S. HARRISON STREET CITY: SANDY STATE: UT ZIP: 84070 BUSINESS PHONE: 8013045502 MAIL ADDRESS: STREET 1: PO BOX 4439 CITY: SANDY STATE: UT ZIP: 84091-4439 D 1 primary_doc.xml X0708 D LIVE 0001992569 Prime Special Risk Holding Company, LLC 8722 S. HARRISON STREET SANDY UT UTAH 84070 8013045502 DELAWARE None None Limited Liability Company true 2023 Rick J. Lindsey 8722 S. Harrison Street Sandy UT UTAH 84070 Executive Officer Director Specific titles/positions: Chairman (Manager), Chief Executive Officer and President Peter Flowers 8722 S. Harrison Street Sandy UT UTAH 84070 Director Specific title/position: Manager Todd Bryant 8722 S. Harrison Street Sandy UT UTAH 84070 Director Specific title/position: Manager Leland Chait 8722 S. Harrison Street Sandy UT UTAH 84070 Director Specific title/position: Manager Jeffrey Leman 8722 S. Harrison Street Sandy UT UTAH 84070 Executive Officer Specific titles/positions: Chief Operating Officer and Secretary Richard Bryant 8722 S. Harrison Street Sandy UT UTAH 84070 Executive Officer Specific title/position: President of Underwriting Brent A. Seegmiller 8722 S. Harrison Street Sandy UT UTAH 84070 Executive Officer Specific titles/positions: Chief Financial Officer and Treasurer Mark Fisher 8722 S. Harrison Street Sandy UT UTAH 84070 Executive Officer Specific title/position: General Counsel J.D. Brown 8722 S. Harrison Street Sandy UT UTAH 84070 Executive Officer Specific title/position: Chief Information Officer Thomassie Tommy 8722 S. Harrison Street Sandy UT UTAH 84070 Executive Officer Specific title/position: Chief Risk Officer Frank Lukacs 8722 S. Harrison Street Sandy UT UTAH 84070 Executive Officer Specific title/position: Chief Marketing Officer Insurance No Revenues 06b false 2023-12-06 false true false 500000 975000000 1000000 974000000 false 2 0 0 0 Issuer will reimburse Prime Holdings Insurance Services, Inc for compensation paid to Issuer's officers and managers for their services, but such reimbursement will come from dividends from Prime Special Risk Insurance Company resulting from its profits false Prime Special Risk Holding Company, LLC /s/ Brent A. Seegmiler Brent A. Seegmiller Chief Financial Officer and Treasurer 2023-12-07