Notification of Changes for Business Entity
General Information
Business Entity Name:	INSRESOURCE INC
Incorporation / Formation Date:	01/18/2002
FEIN:	743027664
Ohio License Number:	27336
NPN:	7100795
DBA / Trade Name:	OHIO INSURANCE RESOURCE (NEW)
State of Domicile:	OH
County:	SUMMIT
Business Address
Address 1:	8940 MERRYVALE DR
Address 2:
City:	TWINSBURG
State:	OH
Zip:	44087
Phone:	3305771995
Fax:	3305771998
Business Web Site Address:
Business Email Address:	INSRES@OUTLOOK.COM
Mailing Address
Address 1:	P. O. BOX 1293
Address 2:
City:	TWINSBURG
State:	OH
Zip:	44087
Indicate the type of change you are seeking
Address Change:	YES
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	YES	New DBA/Trade Name:	OHIO MEDICARE SOLUTIONS
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:	DON DEFRANCESCO
Title:	PRESIDENT
Phone Number:	3305771995
Email Address:	INSRES@OUTLOOK.COM