Notification of Changes for Business Entity
General Information
Business Entity Name:	QUALCARE, INC.
Incorporation / Formation Date:
FEIN:	223129563
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	NJ
County:	MIDDLESEX
Business Address
Address 1:	30 KNIGHTSBRIDGE RD
Address 2:
City:	PISCATAWAY
State:	NJ
Zip:	08854
Phone:	7325620833
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	30 KNIGHTSBRIDGE RD
Address 2:
City:	PISCATAWAY
State:	NJ
Zip:	08854
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

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
SHARON SEITZMAN	PRESIDENT			YES	6/16/2017
DAWN WRIGHT-CLESSURAS	PRESIDENT	151546498	YES		6/16/2017

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:	DAVE PAULUK FOR ANNA KRISHTUL, CORPORATE SECRETARY
Title:	COMPLIANCE MANAGER
Phone Number:	860-226-0507
Email Address:	DAVE.PAULUK@CIGNA.COM