Notification of Changes for Business Entity
General Information
Business Entity Name:	CAREZONE FINANCIAL SERVICES LLC
Incorporation / Formation Date:
FEIN:	300882838
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	DE
County:	NEWCASTLE
Business Address
Address 1:	3175 17TH STREET
Address 2:
City:	SAN FRANCISCO
State:	CA
Zip:	94110
Phone:	9162370162
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	3175 17TH STREET
Address 2:
City:	SAN FRANCISOC
State:	CA
Zip:	94110
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
MARK FILICE	MEDICARE SALES AGENT	2731898		YES	12/31/2017
TERESA GESICKI	MEDICARE SALES AGENT	2729027		YES	1/3/2018

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:	CARRIE MCLEAN
Title:	SR. DIRECTOR OF OPERATIONS
Phone Number:	9162370162
Email Address:	LICENSING@CAREZONEINSURANCE.COM