Notification of Changes for Business Entity
General Information
Business Entity Name:	CONNEXTIONS HCI, LLC
Incorporation / Formation Date:
FEIN:	201825933
Ohio License Number:	32779
NPN:	8439754
DBA / Trade Name:
State of Domicile:	FL
County:	ORANGE
Business Address
Address 1:	9395 SOUTH JOHN YOUNG PARKWAY
Address 2:
City:	ORLANDO
State:	FL
Zip:	32819
Phone:	(952) 205-6221
Fax:
Business Web Site Address:
Business Email Address:	OPTUM.LICENSE.MANAGEMENT@OPTUM.COM
Mailing Address
Address 1:	11000 OPTUM CIRCLE
Address 2:	MN101-E013 K. CLARK
City:	EDEN PRAIRIE
State:	MN
Zip:	55344
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

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:	KRISTEN CLARK
Title:	ASSOCIATE DIRECTOR, REGULATORY LICENSING
Phone Number:	(952) 205-6221
Email Address:	OPTUM.LICENSE.MANAGEMENT@OPTUM.COM