Notification of Changes for Business Entity
General Information
Business Entity Name:	MCCONKEY BENEFITS & FINANCIAL SERVICES, LLC
Incorporation / Formation Date:
FEIN:	23-3086396
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	PA
County:	PENNSYLVANIA
Business Address
Address 1:	2555 KINGSTON ROAD SUITE 100
Address 2:
City:	YORK
State:	PA
Zip:	17402
Phone:	7177559266
Fax:
Business Web Site Address:
Business Email Address:	RISAAC@NLCGROUP.US.COM
Mailing Address
Address 1:	2555 KINGSTON ROAD SUITE 100
Address 2:
City:	YORK
State:	PA
Zip:	17402
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

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
NORMAN BASSO	PRESIDENT/SECRETARY	195464087		YES	1/1/18
FRANK EBNER	PRESIDENT	136722599	YES		1/1/18
JEFFREY GLASS	VP & SECRETARY	162484083	YES		1/1/18

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:	ROB ISAAC (LICENSING ADMINISTRATION)
Title:	COO
Phone Number:	2154854130
Email Address:	RISAAC@NLCGROUP.US.COM