Notification of Changes for Business Entity
General Information
Business Entity Name:	INSPHERE INSURANCE SOLUTIONS, INC
Incorporation / Formation Date:
FEIN:	27-027777-1
Ohio License Number:	39897
NPN:	14412207
DBA / Trade Name:	HEALTHMARKETS INSURANCE AGENCY
State of Domicile:	DE
County:	TARRANT
Business Address
Address 1:	9151 BOULEVARD 26
Address 2:
City:	NORTH RICHLAND HILLS
State:	TX
Zip:	76180
Phone:	817-255-3454
Fax:
Business Web Site Address:
Business Email Address:	ONBOARDING@INSPHEREHQ.COM
Mailing Address
Address 1:	9151 BOULEVARD 26
Address 2:
City:	NORTH RICHLAND HILLS
State:	TX
Zip:	76180
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
KENNETH BRETT HARRISON	PRODUCER	8855445	YES		01/20/2017
KENNETH KRAKE	PRODUCER	17741516	YES		01/20/2017
KRISTJAN SUFAJ	PRODUCER	16940431	YES		01/20/2017
LD GREEN JR	PRODUCER	9295899	YES		01/20/2017
LORI ANN CRANMORE	PRODUCER	17756180	YES		01/20/2017
LUIS FELICIANO	PRODUCER	17223888	YES		01/20/2017
LYDIA BREDSHALL	PRODUCER	1799543	YES		01/20/2017
NATHAN SCHALLER	PRODUCER	12901666	YES		01/20/2017
NOELIA ZAMORA	PRODUCER	15728372	YES		01/20/2017
PATRICK EUGENE BROWN SR	PRODUCER	14588765	YES		01/20/2017
PERRY ALEXANDER FARRELL	PRODUCER	8993855	YES		01/20/2017
PETER BAKAS	PRODUCER	1462994	YES		01/20/2017
PHILLIP KING	PRODUCER	9531039	YES		01/20/2017
RANDALL VINCENT RICHARDS	PRODUCER	1057409	YES		01/20/2017
RICKY GENE ROBINSON	PRODUCER	17428076	YES		01/20/2017

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)	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:	JAMES C MASON
Title:	SR VICE PRESIDENT
Phone Number:	8172553454
Email Address:	ONBOARDING@INSPHEREHQ.COM