Notification of Changes for Business Entity
General Information
Business Entity Name:	WHOLEHEALTH NETWORKS, INC.
Incorporation / Formation Date:
FEIN:	391945651
Ohio License Number:	35250
NPN:	7997214
DBA / Trade Name:
State of Domicile:	DE
County:	KENT
Business Address
Address 1:	20098 ASHBROOK PL
Address 2:	SUITE 250
City:	ASHBURN
State:	VA
Zip:	20147
Phone:	703 439-6629
Fax:
Business Web Site Address:
Business Email Address:	PAMELA.DEWEESE@TIVITYHEALTH.COM
Mailing Address
Address 1:	20098 ASHBROOK PL
Address 2:	SUITE 250
City:	ASHBURN
State:	VA
Zip:	20147
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:	PAMELA DEWEESE
Title:	MANAGER, COMPLIANCE
Phone Number:	703 439-6629
Email Address:	PAMELA.DEWEESE@TIVITYHEALTH.COM