Notification of Changes for Business Entity
General Information
Business Entity Name:	MCGOHAN BRABENDER SENIOR SOLUTIONS LLC
Incorporation / Formation Date:
FEIN:	26-0749754
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	MONTGOMERY
Business Address
Address 1:	9080 SPRINGBORO PIKE STE 100
Address 2:
City:	MIAMISBURG
State:	OH
Zip:	45342
Phone:	877-222-1942
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	9080 SPRINGBORO PIKE STE 100
Address 2:
City:	MIAMISBURG
State:	OH
Zip:	45036
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
DEBRA J ALEXANDER	AGENT	17517295	YES		10/15/2016
NANCY DETAMORE	AGENT	18061087	YES		10/15/2016
ELIZABETH DUCKRO	AGENT	18025287	YES		10/15/2016
DEVIN ANDREW FOLEY	AGENT	18030646	YES		10/15/2016
NANCY LOY FRANK	AGENT	10085449	YES		10/15/2016
JENNIFER MARIE MOSER	AGENT	17859481	YES		10/15/2016
GORDON ANDREW LOWDEN	AGENT	18065749	YES		10/15/2016
AIMEE MADLIGER	AGENT	17862962	YES		10/15/2016

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:	RENEE ADAMS
Title:	LICENSING/ONBOARDING SPECIALIST
Phone Number:	877-222-1942
Email Address:	RADAMS@MBSENIORSOLUTIONS.COM