Notification of Changes for Business Entity
General Information  
Business Entity Name: REMARK USA, INC.
Incorporation / Formation Date:  
FEIN: 411714043
Ohio License Number:
NPN: 659889
DBA / Trade Name:  
State of Domicile: MN
County: N/A
Business Address  
Address 1: 3033 CAMPUS DRIVE
Address 2:  
City: PLYMOUTH
State: MN
Zip: 55441
Phone: 7637465361
Fax:  
Business Web Site Address:  
Business Email Address:  
Mailing Address  
Address 1: 3033 CAMPUS DRIVE STE W205
Address 2:  
City: PLYMOUTH
State: MN
Zip: 55441
   
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
BEVERLY ANN HJULBERG VICE PRESIDENT 470780182   YES 03/07/2018
BEVERLY ANN HJULBERG PRESIDENT 470780182   YES 03/07/2018
ROBIN HYNDLEY PRESIDENT NP4004443C   YES 03/07/2018
SEAN ROWLEY OFFICER 267049511   YES 03/07/2018
STEPHEN COLLINS PRESIDENT 503560248   YES 03/07/2018
STEPHEN COLLINS OFFICER 503560248   YES 03/07/2018
STEPHEN COLLINS DIRECTOR 503560248   YES 03/07/2018
STEPHEN COLLINS DIRECTOR 503560248   YES 03/07/2018
RICHARD MARTIN DE SOUSA DIRECTOR 379612914 YES   03/07/2018
NA JIA PRESIDENT NO SSN YES   03/07/2018
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)
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: CHRISTY KRICK
Title: LICENSING ADMINISTRATOR
Phone Number: 8124942472
Email Address: CKRICK@SUPPORTIVEIS.COM