0001922384-22-000001.txt : 20220408 0001922384-22-000001.hdr.sgml : 20220408 20220408110511 ACCESSION NUMBER: 0001922384-22-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20220408 DATE AS OF CHANGE: 20220408 EFFECTIVENESS DATE: 20220408 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Providence Indemnity Insurance Company, Ltd. CENTRAL INDEX KEY: 0001922384 IRS NUMBER: 300310314 STATE OF INCORPORATION: W7 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-441033 FILM NUMBER: 22815909 BUSINESS ADDRESS: STREET 1: 3740 DAVINCI COURT STREET 2: SUITE 130 CITY: NORCROSS STATE: GA ZIP: 30092 BUSINESS PHONE: 7702554910 MAIL ADDRESS: STREET 1: 3740 DAVINCI COURT STREET 2: SUITE 130 CITY: NORCROSS STATE: GA ZIP: 30092 D 1 primary_doc.xml X0708 D LIVE 0001922384 Providence Indemnity Insurance Company, Ltd. 3740 DAVINCI COURT SUITE 130 NORCROSS GA GEORGIA 30092 7702554910 TURKS AND CAICOS ISLANDS None None Other Ltd. true 2017 Gene B Hubbard Jr. 418 Old Magee Road Magee MS MISSISSIPPI 39111 Executive Officer Insurance Decline to Disclose 06b false true true true Participation contract false 100000 Indefinite 0 Indefinite false 0 0 0 0 false Providence Indemnity Insurance Company, Ltd. G. Bennet Hubbard G. Bennet Hubbard President/Director 2022-03-24