Notification of Changes for Business Entity
General Information
Business Entity Name:	KEMBA FINANCIAL CREDIT UNION
Incorporation / Formation Date:
FEIN:	316034826
Ohio License Number:	1108515
NPN:	8406521
DBA / Trade Name:
State of Domicile:	OH
County:	FRANKLIN
Business Address
Address 1:	555 OFFICENTER PLACE
Address 2:
City:	GAHANNA
State:	OH
Zip:	43230
Phone:	614-235-2395
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	PO BOX 307370
Address 2:
City:	GAHANNA
State:	OH
Zip:	43230
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
JEANA DAVIS	AGENT	11533960	YES		08/05/08
DERRICK MANLEY	AGENT	3697628	YES		09/26/00
DON AYCOCK	AGENT	16617712	YES		04/19/12
TONY PICKENS	AGENT	3239664	YES		02/18/11
BRIDGET WALLS	AGENT	8668171	YES		05/20/13
JESSE BURKE	AGENT	983924	YES		02/12/13
STEPHANIE WATKINS	AGENT	7993833	YES		04/24/11
JASON HUNT	AGENT	4802291	YES		01/24/13
DYLAN WALLS	AGENT	17030670	YES		08/08/13
CHAD FRAZIER	AGENT	16953603	YES		05/03/13
TIFFANY YARNELL	AGENT	16825296	YES		11/08/12
JEFF SEBASTIAN	AGENT	17058255	YES		09/10/13
RYAN AMBROSE	AGENT	3343568	YES		11/02/11
AUDREY RIDDLE	AGENT	16979805	YES		05/16/13
CANDACE SHEARER	AGENT	17059448	YES		01/23/14

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
ROB SULLIVAN	AGENT	8903146	YES		02/01/14
JESSICA SMITH	AGENT	16979805	YES		06/06/13
ADAM FAUSNAUGH	AGENT	17059448	YES		09/11/13
MATT MCKINNEY	AGENT	17132694	YES		12/06/13
ERIC FORREST	AGENT	1485880	YES		03/03/14
STEVE HALLER	AGENT	17260032	YES		05/05/14
JOE KAMINSKI	AGENT	17324989	YES		07/21/14
ADAM RIVERA	AGENT	17404089	YES		10/22/14
MIKE VIDMAR	AGENT	17407043	YES		10/24/14
RON CHAPMAN	AGENT	17419515	YES		11/06/14

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)	YES
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?	YES
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement	CREDIT UNION

Submitted By
Submitted By:	MARIA SMITH
Title:	EXECUTIVE ASSISTANT
Phone Number:	614-729-1399
Email Address:	MSMITH@KEMBA.ORG