Notification of Changes for Business Entity
General Information
Business Entity Name:	LEVEL FUNDED HEALTH PARTNERS, LLC
Incorporation / Formation Date:
FEIN:	472029689
Ohio License Number:	1043169
NPN:	17394686
DBA / Trade Name:
State of Domicile:	DE
County:	DOVER
Business Address
Address 1:	9 EAST LOOCKERMAN
Address 2:
City:	DOVER
State:	DE
Zip:	19901
Phone:	847-340-8190
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	100 S SAUNDERS, FIRST FL
Address 2:
City:	LAKE FOREST
State:	IL
Zip:	60045
Indicate the type of change you are seeking
Address Change:	YES
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:	VESNA YOUNG
Title:	LICENSING
Phone Number:	7083026707
Email Address:	VESNA@LEVELFUNDED.COM