Notification of Changes for Business Entity
General Information
Business Entity Name:	EBIX HEALTH ADMINISTRATION EXCHANGE, INC.
Incorporation / Formation Date:	08/14/1961
FEIN:	35-1640589
Ohio License Number:	12731
NPN:	2014649
DBA / Trade Name:
State of Domicile:	IN
County:	FORT WAYNE
Business Address
Address 1:	10315 DAWSON CREEK BLVD UNIT J
Address 2:
City:	FT WAYNE
State:	IN
Zip:	46825
Phone:	6028701400
Fax:
Business Web Site Address:
Business Email Address:	KELLY.MANUEL@IHCGROUP.COM
Mailing Address
Address 1:	5450 E HIGH STREET STE 300
Address 2:
City:	PHOENIX
State:	AZ
Zip:	85054
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
BRIAN DOW	DRLP	7659339		YES	5/1/2018
DAVID HOLTON	DRLP	16608604	YES		5/1/2018

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)
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:	KELLY MANUEL
Title:	COMPLIANCE SPECIALIST
Phone Number:	6028616035
Email Address:	KELLY.MANUEL@IHCGROUP.COM