Notification of Changes for Business Entity
General Information
Business Entity Name:	AETNA STUDENT HEALTH AGENCY, INC.
Incorporation / Formation Date:	07/30/1980
FEIN:	04-2708160
Ohio License Number:	30478
NPN:	963962
DBA / Trade Name:	NOT APPLICABLE
State of Domicile:	MA
County:	MIDDLESEX
Business Address
Address 1:	77 SOUTH BEDFORD STREET
Address 2:
City:	BURLINGTON
State:	MA
Zip:	01803
Phone:	(781) 219-9100
Fax:
Business Web Site Address:
Business Email Address:	JXGARCIA@AETNA.COM
Mailing Address
Address 1:	151 FARMINGTON AVE, RW61 ROUX-HALLORAN
Address 2:
City:	HARTFORD
State:	CT
Zip:	06156
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

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
JOHN PATRICK MARONEY	TREASURER	046-80-7004	YES		01/01/2017
ELAINE ROSE COFRANCESCO	TREASURER	040-62-4637		YES	01/01/2017

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:	EDWARD C. LEE
Title:	CLERK
Phone Number:	860-273-8329
Email Address:	LEEE1@AETNA.COM