Notification of Changes for Business Entity
General Information
Business Entity Name:	AETNA HEALTH MANAGEMENT LLC
Incorporation / Formation Date:	06/19/1992
FEIN:	133670795
Ohio License Number:	13156
NPN:	2257432
DBA / Trade Name:
State of Domicile:	DE
County:	NEW CASTLE
Business Address
Address 1:	151 FARMINGTON AVENUE (ROUX-HALLORAN, RW61)
Address 2:
City:	HARTFORD
State:	CT
Zip:	06156
Phone:	860-273-0123
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	151 FARMINGTON AVENUE (ROUX-HALLORAN, RW61)
Address 2:
City:	HARTFORD
State:	CT
Zip:	06156
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

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
SCOTT NAI	CONTROLLER	044463266		YES	05/29/17
PATRICK HAMILTON	CONTROLLER	044748251	YES		05/29/17

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:	EDWARD C. LEE
Title:	VICE PRESIDENT AND SECRETARY
Phone Number:	860-273-8329
Email Address:	LEEE1@AETNA.COM