Notification of Changes for Business Entity
General Information
Business Entity Name:	RYAN SERVICES GROUP, LLC
Incorporation / Formation Date:
FEIN:	27-2845143
Ohio License Number:	41618
NPN:	15901407
DBA / Trade Name:
State of Domicile:	IL
County:	COOK
Business Address
Address 1:	180 N. STETSON AVENUE SUITE 4600
Address 2:
City:	CHICAGO
State:	IL
Zip:	60601
Phone:	312-784-6001
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	6455 SOUTH YOSEMITE STREET SUITE 100
Address 2:
City:	GREENWOOD VILLAGE
State:	CO
Zip:	80111
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
KIERAN DEMPSEY	EXECUTIVE VICE PRESIDENT	8528014	YES		01/30/2017
BRENDAN MULSHINE	CHIEF UNDERWRITING MANAGER	724986		YES	01/30/2017

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:	NICOLE LYNN
Title:	LICENSING COORDINATOR
Phone Number:	720-457-9566
Email Address:	NICOLE.LYNN@RYANSG.COM