0001813998-24-000004.txt : 20240404 0001813998-24-000004.hdr.sgml : 20240404 20240404132834 ACCESSION NUMBER: 0001813998-24-000004 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20240404 DATE AS OF CHANGE: 20240404 EFFECTIVENESS DATE: 20240404 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Derivita, Inc. CENTRAL INDEX KEY: 0001813998 ORGANIZATION NAME: IRS NUMBER: 474945034 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-509669 FILM NUMBER: 24822546 BUSINESS ADDRESS: STREET 1: 50 W BROADWAY STREET 2: SUITE 333 CITY: SALT LAKE CITY STATE: UT ZIP: 84101 BUSINESS PHONE: (801) 851-5522 MAIL ADDRESS: STREET 1: 50 W BROADWAY STREET 2: SUITE 333 CITY: SALT LAKE CITY STATE: UT ZIP: 84101 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 Director Mark Webb 50 W Broadway Suite 333 Salt Lake City UT UTAH 84101 Executive Officer Director Kriti Bansal 50 W Broadway Suite 333 Salt Lake City UT UTAH 84101 Director Jennifer Carolan 50 W Broadway Suite 333 Salt Lake City UT UTAH 84101 Director Other Technology Decline to Disclose 06b false 2024-03-22 false true false 100000 10000000 10000000 0 false 4 0 0 0 false Derivita, Inc. /s/ Devlin Daley Devlin Daley Chief Executive Officer 2024-04-04