Notification of Changes for Business Entity
General Information
Business Entity Name:	BENEFITS TECHNOLOGIES, LLC
Incorporation / Formation Date:	2/25/2004
FEIN:	20-0815714
Ohio License Number:	1091999
NPN:	9132752
DBA / Trade Name:
State of Domicile:	OK
County:	CREEK
Business Address
Address 1:	1200 E. TAFT AVE
Address 2:
City:	SAPULPA
State:	OK
Zip:	74066
Phone:	918-293-2014
Fax:
Business Web Site Address:	WWW.BENTECWORKPLACE.COM
Business Email Address:	WWW.BENTECWORKPLACE.COM
Mailing Address
Address 1:	1200 E. TAFT AVE
Address 2:
City:	SAPULPA
State:	OK
Zip:	74066
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	YES	New DBA/Trade Name:	BENTEC WORKPLACE SOLUTIONS
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

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:	SUZANNE ENDSLEY
Title:	ADMINISTRATIVE ASST.
Phone Number:	918-293-2014
Email Address:	SUZANNE.ENDSLEY@BENTECLLC.COM