Notification of Changes for Business Entity
General Information
Business Entity Name:	MEDASSETS INSURANCE SOLUTIONS, LLC
Incorporation / Formation Date:
FEIN:	273449890
Ohio License Number:
NPN:	15974565
DBA / Trade Name:
State of Domicile:	TX
County:	IRVING
Business Address
Address 1:	290 E JOHN CARPENTER FWY
Address 2:
City:	IRVING
State:	TX
Zip:	75062
Phone:	9728300025
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	290 E JOHN CARPENTER FWY
Address 2:
City:	IRVING
State:	TX
Zip:	75062
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
DAVID SMITH	PRESIDENT/TREASURER	3308827	YES		07/12/2018
MARK STENMARK	VICE PRESIDENT/SECRETARY	15199856	YES		07/12/2018
MISTY BRODIGAN	PRESIDENT	15538931		YES	07/12/2018

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)	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:	EILEEN MICKLER
Title:	LICENSING ADMINISTRATOR
Phone Number:	812-886-0191
Email Address:	EMICKLER@SUPPORTIVEIS.COM