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:	N. 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:	N. 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
ALISA R ROBINSON	PRODUCER	17606608	YES		10-19-16
AUDRELYN B ELLIS	PRODUCER	4714888	YES		10-19-16
BEATRICE D WATERS	PRODUCER	18020053	YES		10-19-16
BENJAMIN CONSTANT	PRODUCER	15746301	YES		10-19-16
BRUCE E ELIOT	PRODUCER	1118541	YES		10-19-16
CAROL MITCHELL	PRODUCER	18080094	YES		10-19-16
CATHERINE LESLIE ROWE	PRODUCER	17608526	YES		10-19-16
CICELY CARROLL	PRODUCER	18123018	YES		10-19-16
CYNTHIA CARMONA	PRODUCER	8451965	YES		10-19-16
DAVID W TEMPLETON	PRODUCER	7312129	YES		10-19-16
EMMA MOSS	PRODUCER	16182104	YES		10-19-16
GILBERT PRITCHETT	PRODUCER	17925954	YES		10-19-16
GORDON MANTEY SALLAS MENSAH	PRODUCER	17287542	YES		10-19-16
JEFFERY W BENEDICT	PRODUCER	16232783	YES		10-19-16
JOE KELLY JACKSON	PRODUCER	15984285	YES		10-19-16

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