0001700167-18-000003.txt : 20180508 0001700167-18-000003.hdr.sgml : 20180508 20180508153430 ACCESSION NUMBER: 0001700167-18-000003 CONFORMED SUBMISSION TYPE: D/A PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20180508 DATE AS OF CHANGE: 20180508 EFFECTIVENESS DATE: 20180508 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Covered Insurance Solutions, Inc. CENTRAL INDEX KEY: 0001700167 IRS NUMBER: 814512828 STATE OF INCORPORATION: SD FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D/A SEC ACT: 1933 Act SEC FILE NUMBER: 021-307325 FILM NUMBER: 18814319 BUSINESS ADDRESS: STREET 1: 4884 CLIFF DRIVE CITY: RAPID CITY STATE: SD ZIP: 57702 BUSINESS PHONE: 605-209-1062 MAIL ADDRESS: STREET 1: 4884 CLIFF DRIVE CITY: RAPID CITY STATE: SD ZIP: 57702 D/A 1 primary_doc.xml X0708 D/A LIVE 0001700167 Covered Insurance Solutions, Inc. 4884 CLIFF DRIVE RAPID CITY SD SOUTH DAKOTA 57702 605-209-1062 SOUTH DAKOTA None None Corporation true 2016 Ross Diedrich 4884 Cliff Drive Rapid City SD SOUTH DAKOTA 57702 Executive Officer Director Promoter Michael Diedrich 4884 Cliff Drive Rapid City SD SOUTH DAKOTA 57702 Executive Officer Director Promoter Christopher Diedrich 2946 S. Bannock Street Englewood CO COLORADO 80110 Executive Officer Director Promoter David Fitzgerald 4884 Cliff Drive Rapid City SD SOUTH DAKOTA 57702 Director Other Technology Decline to Disclose 06b true 0001700167-18-000001 2018-02-23 false true true true true Promissory notes convertible into equity securities of the Issuer. false 0 1250000 750000 500000 false 11 0 0 0 false Covered Insurance Solutions, Inc. /s/ Ross P. Diedrich Ross P. Diedrich President 2018-05-08