0001911715-22-000001.txt : 20220519 0001911715-22-000001.hdr.sgml : 20220519 20220519132045 ACCESSION NUMBER: 0001911715-22-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20220519 DATE AS OF CHANGE: 20220519 EFFECTIVENESS DATE: 20220519 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Embedded Insurance Inc. CENTRAL INDEX KEY: 0001911715 IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-446249 FILM NUMBER: 22942011 BUSINESS ADDRESS: STREET 1: 1389 CENTER DRIVE, SUITE 200 CITY: PARK CITY STATE: UT ZIP: 84098 BUSINESS PHONE: 801-414-1481 MAIL ADDRESS: STREET 1: 1389 CENTER DRIVE, SUITE 200 CITY: PARK CITY STATE: UT ZIP: 84098 D 1 primary_doc.xml X0708 D LIVE 0001911715 Embedded Insurance Inc. 1389 CENTER DRIVE, SUITE 200 PARK CITY UT UTAH 84098 801-341-9596 DELAWARE None None Corporation true 2021 James Hall 1389 Center Drive, Suite 200 Park City UT UTAH 84098 Executive Officer Director Promoter Mona Elliason c/o 1389 Center Drive, Suite 200 Park City UT UTAH 84098 Director Mungo Wilson c/o 1389 Center Drive, Suite 200 Park City UT UTAH 84098 Director Adrian Hummel 1389 Center Drive, Suite 200 Park City UT UTAH 84098 Executive Officer Other Technology Decline to Disclose 06b false 2021-11-30 false true false 1 27500000 22476131 5023869 false 43 0 0 0 false Embedded Insurance Inc. /s/ Adrian Hummel Adrian Hummel Secretary 2022-05-19