Notification of Changes for Business Entity
General Information
Business Entity Name:	INSPHERE INSURANCE SOLUTIONS, INC.
Incorporation / Formation Date:
FEIN:	27-027777-1
Ohio License Number:	39897
NPN:	14412207
DBA / Trade Name:	HEALTHMARKETS INSURANCE AGENCY
State of Domicile:	DE
County:	TARRANT
Business Address
Address 1:	9151 BOULEVARD 26
Address 2:
City:	NORTH RICHLAND HILLS
State:	TX
Zip:	76180
Phone:	817-255-3454
Fax:
Business Web Site Address:
Business Email Address:	ONBOARDING@HEALTHMARKETSHQ.COM
Mailing Address
Address 1:	9151 BOULEVARD 26
Address 2:
City:	NORTH RICHLAND HILLS
State:	TX
Zip:	76180
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
DONALD EBNER	PRODUCER	11024079		YES	04-20-2017
DWAYNE CHAPMAN	PRODUCER	16678655		YES	04-20-2017
EDWIN NOWLAN	PRODUCER	17061505		YES	04-20-2017
ERIC CREAN	PRODUCER	17615934		YES	04-20-2017
GARY KINNARD	PRODUCER	8340402		YES	04-20-2017
GENE C GATES	PRODUCER	8025238		YES	04-20-2017
GERARD A LADALARDO JR	PRODUCER	2663453		YES	04-20-2017
GIGI PHILLIPS	PRODUCER	17533445		YES	04-20-2017
HOOMAN HADAVAND	PRODUCER	10799556		YES	04-20-2017
JASSEN L GARNER	PRODUCER	3394617		YES	04-20-2017
JEAN M GHALY	PRODUCER	17473180		YES	04-20-2017
JEFFERY W BENEDICT	PRODUCER	16232783		YES	04-20-2017
JOE KELLY JACKSON	PRODUCER	15984285		YES	04-20-2017
JOHN VANDERPLAS	PRODUCER	7909592		YES	04-20-2017
JOHNNIE MACK SANDERS	PRODUCER	6489705		YES	04-20-2017

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)	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 C. MASON
Title:	SR. VICE PRESIDENT
Phone Number:	817-255-3454
Email Address:	ONBOARDING@HEALTHMARKETSHQ.COM