Notification of Changes for Business Entity
General Information
Business Entity Name:	FUTURITY FIRST INSURANCE GROUP INC.
Incorporation / Formation Date:
FEIN:	26-1553785
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	DE
County:	NEW CASTLE
Business Address
Address 1:	101 CENTERPOINT DR STE 208
Address 2:
City:	MIDDLETOWN
State:	CT
Zip:	06457
Phone:	402-343-3634
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	8420 W DODGE RD STE 510
Address 2:
City:	OMAHA
State:	NE
Zip:	68114
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
LEON MENSAH	PRODUCER	8550388	YES		05/04/2018
DONTEAKO E WILSON	PRODUCER	9864163	YES		05/04/2018
CHRIS WESLEY WALTERS	PRODUCER	15700280	YES		05/04/2018
DOMINIQUE D SIMPSON JR	PRODUCER	17044322	YES		05/04/2018
JOHN RICHARD KOSTRABA SR	PRODUCER	8943355	YES		05/04/2018
WILLIAM PAUL KARDOS	PRODUCER	12868762	YES		05/04/2018
MATTHEW TIMOTHY ADAMS	PRODUCER	14066536	YES		05/04/2018
TODD M LUNIEWSKI	PRODUCER	2024833	YES		05/04/2018
JOHN LIONEL JOHNSON	PRODUCER	8733373	YES		05/04/2018
BRENT BAILEY PALMER	PRODUCER	17652799	YES		05/04/2018

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date

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:	HERSHEL KLEINBERG
Title:	CHAIRMAN OF BOARD
Phone Number:	402-343-3634
Email Address:	CYNTHIA@SENIORMARKETSALES.COM