Notification of Changes for Business Entity
General Information
Business Entity Name:	ADVENTIST RISK MANAGEMENT, INC.
Incorporation / Formation Date:	05/17/1995
FEIN:	52-1966740
Ohio License Number:	983189
NPN:	16833007
DBA / Trade Name:
State of Domicile:	MD
County:	USA
Business Address
Address 1:	12501 OLD COLUMBIA PIKE
Address 2:
City:	SILVER SPRING
State:	MD
Zip:	20904
Phone:	888-951-4276
Fax:
Business Web Site Address:	HTTP://WWW.ADVENTISTRISK.ORG
Business Email Address:	RVICENTE@ADVENTISTRISK.ORG
Mailing Address
Address 1:	ARM COMPLIANCE
Address 2:	12501 OLD COLUMBIA PIKE
City:	SILVER SPRING
State:	MD
Zip:	20904
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	NO	New DBA/Trade Name:
Amend DBA/Trade Name:	NO	Old DBA/Trade Name:
Add/Delete Producers, Members, Owners, Partners, Officers and/or Directors:	YES

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
DAVID J. FOURNIER	VP/CHIEF CLIENT CARE OFFICER	17720611	YES		6/6/2017
ELLEN R. ELDRIDGE	VICE PRESIDENT/RDA	951562		YES	6/1/2017

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
JERMAINE K. JACKSON	VP/TRE/CFO	507158735	YES		3/16/2014
ROBERT H. BURROW	VP/SEC/CHIEF LEGAL OFFICER	120580629	YES		6/16/2014
DANIEL R. JACKSON	DIRECTOR/VICE CHAIR	369688069	YES		3/16/2014
TIMOTHY E. NORTHROP	PRESIDENT	939668	YES		4/13/2016
TIMOTHY E. NORTHROP	VICE PRESIDENT	939668		YES	4/13/2016
ARTHUR F. BLINCI	VICE PRESIDENT	384583055		YES	10/1/2015
ANTONIO G. VARGAS	VICE PRESIDENT/CIO	542969230	YES		6/1/2017

Title Business Entities Only
1. Is any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance? (i.e. banking, auto dealer, mortgage company)
2. Has any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance since the filing of the previous CN-65 or the original application?
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement

Submitted By
Submitted By:	ROBERT H. BURROW
Title:	VICE PRESIDENT/CORP. SEC'Y/CHIEF LEGAL OFFICER
Phone Number:	301-680-3821
Email Address:	RVICENTE@ADVENTISTRISK.ORG