0001700167-19-000002.txt : 20190320 0001700167-19-000002.hdr.sgml : 20190320 20190320134726 ACCESSION NUMBER: 0001700167-19-000002 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20190320 DATE AS OF CHANGE: 20190320 EFFECTIVENESS DATE: 20190320 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Covered Insurance Solutions, Inc. CENTRAL INDEX KEY: 0001700167 IRS NUMBER: 814512828 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-335287 FILM NUMBER: 19694323 BUSINESS ADDRESS: STREET 1: 1177 GRANT STREET STREET 2: #302 CITY: DENVER STATE: CO ZIP: 80203 BUSINESS PHONE: 605-209-1062 MAIL ADDRESS: STREET 1: 1177 GRANT STREET STREET 2: #302 CITY: DENVER STATE: CO ZIP: 80203 D 1 primary_doc.xml X0708 D LIVE 0001700167 Covered Insurance Solutions, Inc. 1177 GRANT STREET #302 DENVER CO COLORADO 80203 605-209-1062 DELAWARE None None Corporation true 2016 Ross Diedrich 1177 Grant Street #302 Denver CO COLORADO 80203 Executive Officer Director Promoter Michael Diedrich 1177 Grant Street #302 Denver CO COLORADO 80203 Executive Officer Director Promoter Christopher Diedrich 1177 Grant Street #302 Denver CO COLORADO 80203 Executive Officer Director Promoter David Fitzgerald 1177 Grant Street #302 Denver CO COLORADO 80203 Director Michael Sandler 1177 Grant Street #302 Denver CO COLORADO 80203 Director Other Technology Decline to Disclose 06b false 2019-03-06 false true false 0 3674910 3039751 635159 Amount includes conversion of outstanding convertible promissory notes. false 20 0 0 0 false Covered Insurance Solutions, Inc. /s/ Ross P. Diedrich Ross P. Diedrich President 2019-03-20