Notification of Changes for Business Entity
General Information
Business Entity Name:	INSPHERE INSURANCE SOLUTIONS INC.
Incorporation / Formation Date:
FEIN:	27-027777-1
Ohio License Number:	39897
NPN:	14412207
DBA / Trade Name:	HEALTHMARKETS INSURANCE AGENCY
State of Domicile:	DE
County:	TARRANT
Business Address
Address 1:	9151 BOULEVARD 26
Address 2:
City:	NORTH RICHLAND HILLS
State:	TX
Zip:	76180
Phone:	817-255-3454
Fax:
Business Web Site Address:
Business Email Address:	ONBOARDING@HEALTHMARKETSHQ.COM
Mailing Address
Address 1:	9151 BOULEVARD 26
Address 2:
City:	NORTH RICHLAND HILLS
State:	TX
Zip:	76180
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
AMBER JANEE FIESS	PRODUCER	17673551	YES		04/05/2016
CARL N JENSEN	PRODUCER	2263699	YES		04/05/2016
CHAUNCEY EARL MOORE	PRODUCER	15778654	YES		04/05/2016
CHERYL MAE THOMAS	PRODUCER	17863779	YES		04/05/2016
CHRISTINA MARIE PENA	PRODUCER	16435061	YES		04/05/2016
DANIEL WALTER GIBSON	PRODUCER	17852120	YES		04/05/2016
DENISE A KRAVEC	PRODUCER	17797731	YES		04/05/2016
DENISHA LATORSHA DOWNEY	PRODUCER	15696387	YES		04/05/2016
DWAYNE GORDON	PRODUCER	17816729	YES		04/05/2016
ERICH SHANHOLTZER	PRODUCER	16727858	YES		04/05/2016
GIL CODY	PRODUCER	16296835	YES		04/05/2016
GWENDOLYN DUKES	PRODUCER	16117174	YES		04/05/2016
JACK NICOLAS WATTS	PRODUCER	17452049	YES		04/05/2016
JACK ROLAND PIKE JR	PRODUCER	17129829	YES		04/05/2016
JOHN MARCUS REAL	PRODUCER	17604817	YES		04/05/2016

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)	NO
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?	NO
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:	JAMES C. MASON
Title:	SR. VICE PRESIDENT
Phone Number:	817-255-3454
Email Address:	ONBOARDING@HEALTHMARKETSHQ.COM