Notification of Changes for Business Entity
General Information
Business Entity Name:	HEALTH PLANS, INC.
Incorporation / Formation Date:	07/01/1981
FEIN:	04-2734278
Ohio License Number:	12730
NPN:
DBA / Trade Name:	HEALTH PLANS, INC. OF MASSACHUSETTS
State of Domicile:	MA
County:	WORCESTER
Business Address
Address 1:	1500 WEST PARK DRIVE
Address 2:	SUITE 330
City:	WESTBOROUGH
State:	MA
Zip:	01581
Phone:	800-343-7674
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	P.O. BOX 5199
Address 2:
City:	WESTBOROUGH
State:	MA
Zip:	01581
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
MICHAEL A. CARSON	CHAIR OF BOARD	215115469	YES		06/12/2018

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)
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?
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:	DEBORAH M. HODGES
Title:	PRESIDENT
Phone Number:	508-475-6804
Email Address:	VBEZOENIK@HEALTHPLANSINC.COM