Notification of Changes for Business Entity
General Information
Business Entity Name:	HEALTH BENEFITS ONE LLC
Incorporation / Formation Date:
FEIN:	455202195
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	FL
County:	BROWARD
Business Address
Address 1:	200 S. PARK ROAD
Address 2:	SUITE 465
City:	HOLLYWOOD
State:	FL
Zip:	33021
Phone:	800-492-1834 X4000
Fax:
Business Web Site Address:
Business Email Address:	SUPPORT@HBCINSURE.COM
Mailing Address
Address 1:	200 S. PARK ROAD
Address 2:	SUITE 465
City:	HOLLYWOOD
State:	FL
Zip:	33021
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
GUIGNARD, JEAN	PRODUCER	17743397	YES		04/12/2016
AUGUSTE, JEFFREY	PRODUCER	17389467	YES		04/12/2016
FUCCILLO, JOAN LYNN	PRODUCER	3639108	YES		04/12/2016
KAUFMAN, JONATHAN B	PRODUCER	11466978	YES		04/12/2016
HENRY, JONATHAN	PRODUCER	17210419	YES		04/12/2016
SILER, JULIAN DUJUAN	PRODUCER	15821236	YES		04/12/2016
BERCOWICZ, JULIO	PRODUCER	423165	YES		04/12/2016
GOLAUB, KASIM	PRODUCER	17722825	YES		04/12/2016
PAZ, KEMBERLY	PRODUCER	17711087	YES		04/12/2016
WILSON, KERRON	PRODUCER	17724262	YES		04/12/2016
TOYER, LASHON LENNON	PRODUCER	7435424	YES		04/12/2016
GRAHAM, MICHAEL ANTHONY	PRODUCER	9581618	YES		04/12/2016
DE LA PIEDRA, MILKA MARIA	PRODUCER	8082317	YES		04/12/2016
LEVINE, MITCHELL DAVID	PRODUCER	14415307	YES		04/12/2016
YAHRLING, ROBERT F	PRODUCER	3822995	YES		04/12/2016

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)	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:	DANIEL GARAVUSO
Title:	DIRECTOR, COMPLIANCE
Phone Number:	8133971493
Email Address:	DGARAVUSO@HIIQUOTE.COM