Notification of Changes for Business Entity
General Information
Business Entity Name:	QUESTAR AGENCY INC
Incorporation / Formation Date:
FEIN:	38-3360512
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	MN
County:	HENNEPIN
Business Address
Address 1:	5701 GOLDEN HILLS DR
Address 2:
City:	MINNEAPOLIS
State:	MN
Zip:	55416
Phone:	888-446-5872
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	5701 GOLDEN HILLS DR
Address 2:
City:	MINNEAPOLIS
State:	MN
Zip:	55416
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
ELISIA LATTIMER	PRODUCER	2097648	YES		09/16/2014
CHARLES LEE	PRODUCER	1686910	YES		12/15/2011
STEPHEN LEITZELL	PRODUCER	616544	YES		10/27/2010
RONALD LOPRESTI	PRODUCER	1917594	YES		04/19/2016
JONATHAN MALONE	PRODUCER	9209091	YES		03/04/2015
ERICA MCCAIN	PRODUCER	3236937	YES		11/19/2010
MICHAEL MCFADDEN	PRODUCER	16539860	YES		02/03/2015
JULIE MCINTOSH	PRODUCER	16483433	YES		09/18/2014
BARRY MILLSON	PRODUCER	547076	YES		10/22/2007
STEPHEN MITSKAVICH	PRODUCER	2755561	YES		11/24/1999
JOHN MORAVEK	PRODUCER	10723123	YES		02/17/2016
AARON REED	PRODUCER	17255119	YES		05/19/2016
DAVID RUSSO	PRODUCER	725828	YES		12/03/2014
ERIC SCHROEDER	PRODUCER	2517739	YES		11/28/2005
BRIAN SENSIBAUGH	PRODUCER	7630979	YES		03/01/2004

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:	JENNA COLEBANK
Title:	LICENSING SPECIALIST
Phone Number:	763-765-7323
Email Address:	LICENSING@US.QUESTARCAPITAL.COM