Notification of Changes for Business Entity
General Information
Business Entity Name:	MEDLINK INC
Incorporation / Formation Date:
FEIN:	611201382
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	KY
County:	JEFFERSON
Business Address
Address 1:	2001 LAKE POINT WAY
Address 2:
City:	LOUISVILLE
State:	KY
Zip:	40223
Phone:	5022451371
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2001 LAKE POINT WAY
Address 2:
City:	LOUISVILLE
State:	KY
Zip:	40223
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
JOHN DANIEL FARLOW	PRODUCER	9538800	YES		07/01/2016

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:	KATHY HAMILTON
Title:	COO
Phone Number:	5022451371
Email Address:	LICENSING@AGENT-LINK.NET