Notification of Changes for Business Entity
General Information
Business Entity Name:	BENSON BLACKBURN, LLC
Incorporation / Formation Date:
FEIN:	202825023
Ohio License Number:	974264
NPN:	8578090
DBA / Trade Name:
State of Domicile:	FL
County:	COLLIER
Business Address
Address 1:	999 VANDERBILT BEACH ROAD, SUIITE 504
Address 2:
City:	NAPLES
State:	FL
Zip:	34108
Phone:	2393481800
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	999 VANDERBILT BEACH ROAD, SUIITE 504
Address 2:
City:	NAPLES
State:	FL
Zip:	34108
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	YES	Old Business Entity Name:	INS MANAGEMENT CONSULTANTS LLC
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

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)	NO
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?	NO
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:	TARA MCCALL
Title:	DIRECTOR CLIENT SERVICES
Phone Number:	2393481800
Email Address:	TMCCALL@IMCWEALTH.COM