Notification of Changes for Business Entity
General Information
Business Entity Name:	COMPASS INSURANCE & FINANCIAL GROUP, LLC
Incorporation / Formation Date:
FEIN:	27-2518899
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	ASHLAND
Business Address
Address 1:	137 W. MAIN ST.
Address 2:
City:	ASHLAND
State:	OH
Zip:	44805
Phone:	4192071111
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	137 W. MAIN ST.
Address 2:
City:	ASHLAND
State:	OH
Zip:	44805
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
LARRY DEAN GOPP	PRODUCER	14215335		YES	01/01/2018
THEODORE C. DETER	AGENT	16179134	YES		01/01/2018
JULIA E. BROWN	AGENT	17560731	YES		01/01/2018

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:	CHAD A. BROWN
Title:	PARTNER & PRINCIPAL AGENT
Phone Number:	4192071111X101
Email Address:	CHADBROWN@COMPASS-INSURANCE.COM