Notification of Changes for Business Entity
General Information
Business Entity Name:	HHS INSURANCE AGENCY, LLC
Incorporation / Formation Date:	08/01/2015
FEIN:	47-4595823
Ohio License Number:	1074107
NPN:	17689062
DBA / Trade Name:
State of Domicile:	OH
County:	GREENE
Business Address
Address 1:	4060 EXECUTIVE DRIVE
Address 2:
City:	BEAVERCREEK
State:	OH
Zip:	45430
Phone:	937-458-3030
Fax:
Business Web Site Address:	HHS-INSURANCE.COM
Business Email Address:
Mailing Address
Address 1:	4060 EXECUTIVE DRIVE
Address 2:
City:	BEAVERCREEK
State:	OH
Zip:	45430
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
GREGORY JOHN POST	AGENT	17007622	YES		10/23/2017
FERNANDO M. BRANQUINHO	AGENT	7900032		YES	10/23/2017

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:	WILLIAM G. UHL II
Title:	PARTNER
Phone Number:	937-434-9090
Email Address:	BILLUHL@UHLAGENCY.COM