0001813998-21-000001.txt : 20211209 0001813998-21-000001.hdr.sgml : 20211209 20211209121036 ACCESSION NUMBER: 0001813998-21-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20211209 DATE AS OF CHANGE: 20211209 EFFECTIVENESS DATE: 20211209 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Derivita, Inc. CENTRAL INDEX KEY: 0001813998 IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-424337 FILM NUMBER: 211481290 BUSINESS ADDRESS: STREET 1: 928 W. VAHE STREET CITY: DRAPER STATE: UT ZIP: 84020 BUSINESS PHONE: (801) 851-5522 MAIL ADDRESS: STREET 1: 928 W. VAHE STREET CITY: DRAPER STATE: UT ZIP: 84020 D 1 primary_doc.xml X0708 D LIVE 0001813998 Derivita, Inc. 50 W Broadway Suite 333 Salt Lake City UT UTAH 84101 (801) 851-5522 DELAWARE None None Corporation true 2019 Devlin Daley 50 W Broadway Suite 333 Salt Lake City UT UTAH 84101 Executive Officer Director Ryan Brown 50 W Broadway Suite 333 Salt Lake City UT UTAH 84101 Executive Officer Jennifer Carolan 50 W Broadway Suite 333 Salt Lake City UT UTAH 84101 Director Cheree Daley 50 W Broadway Suite 333 Salt Lake City UT UTAH 84101 Director Other Technology Decline to Disclose 06b false 2021-11-24 false true false 25000 6000000 4950000 1050000 false 13 0 0 300000 Repayment of loan. false Derivita, Inc. Devlin Daley Devlin Daley CEO 2021-12-09