Notification of Changes for Business Entity
General Information
Business Entity Name:	THRIVENT INSURANCE AGENCY
Incorporation / Formation Date:
FEIN:	741780150
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	MN
County:	HENNEPIN
Business Address
Address 1:	625 FOURTH AVE S
Address 2:
City:	MINNEAPOLIS
State:	MN
Zip:	55415
Phone:	9206285808
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	625 FOURTH AVE S
Address 2:
City:	MINNEAPOLIS
State:	MN
Zip:	55415
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
CHRISTIAN HOLGARD	AGENT	2895022		YES	04/17/18
BRUCE FEAR	AGENT	6763828		YES	4/6/18
RENDI OLSON	AGENT	9915901		YES	4/5/18
THOMAS HENDRICKS	AGENT	270798		YES	3/27/18
ROY MASON	AGENT	1958570		YES	3/27/18
SCOTT SIRIPALAKA	AGENT	8416987		YES	3/27/18
MATTHEW TILLACK	AGENT	18624715		YES	3/27/18
ALEXANDRA PAHNKE	AGENT	17762267	YES		3/19/2018
CHAD AABERG	AGENT	7734392	YES		3/22/2018
JAMIE RIGATTI	AGENT	18622990	YES		3/28/2018
JESSE NIEDERBAUMER	AGENT	6272437	YES		3/29/2018
JENNIFER KREEB	AGENT	3950013	YES		4/2/2018
FRED HUNT	AGENT	5019511	YES		4/2/2018
ALLISON BOLGER	AGENT	16725662	YES		4/5/2018
MARK GRAHAM	AGENT	2067316	YES		4/9/2018

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:	RACHAEL STURM
Title:	SPECIALIST
Phone Number:	9206285808
Email Address:	RACHAEL.STURM@THRIVENT.COM