Notification of Changes for Business Entity
General Information
Business Entity Name:	MMSI, INC.
Incorporation / Formation Date:	02/05/1986
FEIN:	41-1547003
Ohio License Number:	1023730
NPN:	2230691
DBA / Trade Name:	MEDICA HEALTH PLAN SOLUTIONS
State of Domicile:	MN
County:	HENNEPIN
Business Address
Address 1:	401 CARLSON PARKWAY
Address 2:
City:	MINNETONKA
State:	MN
Zip:	55305
Phone:	952-992-3308
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	401 CARLSON PARKWAY
Address 2:	CP250
City:	MINNETONKA
State:	MN
Zip:	55305
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	YES	New DBA/Trade Name:	MEDICA HEALTH PLAN SOLUTIONS
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
MARK L. BAIRD	BOARD MEMBER	N/A	YES		06/19/2018
JAMES P. JACOBSON	BOARD MEMBER	N/A	YES		06/19/2018
RAJESH AGGARWAL	BOARD MEMBER	N/A		YES	06/19/2018
PETER KELLY	BOARD MEMBER	N/A		YES	06/19/2018
SAMUEL LEON	BOARD MEMBER	N/A		YES	06/19/2018
EARL STRATTON	BOARD MEMBER	N/A		YES	06/19/2018
ESTHER TOMLJANOVICH	BOARD MEMBER	N/A		YES	06/19/2018
MARY TWINEM	BOARD MEMBER	N/A		YES	06/19/2018

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:	JAMES P. JACOBSON
Title:	SENIOR VICE PRESIDENT AND SECRETARY
Phone Number:	952-992-3308
Email Address:	SCOTT.BIELOH@MEDICA.COM