Notification of Changes for Business Entity
General Information  
Business Entity Name: ENTIRE INS SOLUTIONS LLC
Incorporation / Formation Date: 04/12/2011
FEIN: 27496808
Ohio License Number: 42500
NPN: 16174854
DBA / Trade Name:  
State of Domicile: GA
County: FULTON
Business Address  
Address 1: 5605 GLENRIDGE DRIVE, NE
Address 2: PREMIER PLAZA, BUILDING ONE, SUITE 670
City: ATLANTA
State: GA
Zip: 30342
Phone: 6785953068
Fax: 8884248120
Business Web Site Address:  
Business Email Address:  
Mailing Address  
Address 1: 5605 GLENRIDGE DRIVE, NE
Address 2: PREMIER PLAZA, BUILDING ONE, SUITE 670
City: ATLANTA
State: GA
Zip: 30342
   
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
DAVID DENNETT-SMITH RDA 16295487 YES   12/10/2015
STEVEN NEEDLE RDA 645632   YES 12/10/2015
STEVEN NEEDLE EMPLOYEE 645632   YES 12/10/2015
           
Members, Owners, Partners, Officers and Directors
Name Title Identifying # Add Delete Eff. Date
FRED BRASCH CFO 118704210 YES   12/10/2015
THOMAS STOUGHTON COO & GENERAL COUNSEL 257761865 YES   12/10/2015
DAVID DENNET-SMITH CHIEF MARKETING & BUSINESS DEV 254554043 YES   12/10/2015
STEPHEN SATLER CEO 076409409 YES   12/10/2015
STEVEN GOLDBERT CHIEF RISK OFFICER 207422455 YES   12/10/2015
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