Notification of Changes for Business Entity
General Information
Business Entity Name:	FCE BENEFIT ADMINISTRATORS, INC
Incorporation / Formation Date:	01/08/1989
FEIN:	33-0330036
Ohio License Number:	40092
NPN:	2751182
DBA / Trade Name:
State of Domicile:	CA
County:	SAN MATEO
Business Address
Address 1:	1528 SO EL CAMINO REAL
Address 2:	SUITE 307
City:	SAN MATEO
State:	CA
Zip:	94402
Phone:	6503410306
Fax:	6503417432
Business Web Site Address:
Business Email Address:	SPORTER@FCEBENEFIT.COM
Mailing Address
Address 1:	1528 SO EL CAMINO REAL
Address 2:	SUITE 307
City:	SAN MATEO
State:	CA
Zip:	94402
Indicate the type of change you are seeking
Address Change:	YES
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

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:	STEVE PORTER
Title:	EVP/COO
Phone Number:	6503410306
Email Address:	SPORTER@FCEBENEFIT.COM