Notification of Changes for Business Entity
General Information
Business Entity Name:	INSPHERE INSURANCE SOLUTIONS, INC.
Incorporation / Formation Date:
FEIN:	27-027777-1
Ohio License Number:	39897
NPN:	14412207
DBA / Trade Name:	HEALTHMARKETS INSURANCE AGENCY
State of Domicile:	DE
County:	TARRANT
Business Address
Address 1:	9151 BOULEVARD 26
Address 2:
City:	N. RICHLAND HILLS
State:	TX
Zip:	76180
Phone:	817-255-3454
Fax:
Business Web Site Address:
Business Email Address:	ONBOARDING@HEALTHMARKETSHQ.COM
Mailing Address
Address 1:	9151 BOULEVARD 26
Address 2:
City:	N. RICHLAND HILLS
State:	TX
Zip:	76180
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
DENISHA LATORSHA DOWNEY	PRODUCER	15696387		YES	10-19-16
JUNE WILLIAMS SCOTT	PRODUCER	10308084		YES	10-19-16
TODD D MUNCY	PRODUCER	2186859		YES	10-19-16
MICHELLE WALDRON	PRODUCER	17853341		YES	10-19-16
CARL DELANE HARRIS	PRODUCER	12362659		YES	10-19-16
CHARLES HATCH	PRODUCER	8697779		YES	10-19-16
GIL CODY	PRODUCER	16296835		YES	10-19-16
MARCOS OLIN RIVERA	PRODUCER	17131387		YES	10-19-16
BRIAN HUNTLEY ADELSTEIN	PRODUCER	8235176		YES	10-19-16
JOHN MORRIS LEAP	PRODUCER	7155256		YES	10-19-16
OLIVIA TENICE WALKER	PRODUCER	1318484		YES	10-19-16
LENDA SOJOURNER	PRODUCER	1862271		YES	10-19-16
CHERYL MAE THOMAS	PRODUCER	17863779		YES	10-19-16
EVINER FAJARDO PIDO	PRODUCER	16924635		YES	10-19-16
PAUL ELLIS THOMAS JR	PRODUCER	17857340		YES	10-19-16

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:	JAMES C. MASON
Title:	SR. VICE PRESIDENT
Phone Number:	817-255-3454
Email Address:	ONBOARDING@HEALTHMARKETSHQ.COM