Notification of Changes for Business Entity
General Information
Business Entity Name:	INSPHERE INSURANCE SOLUTIONS
Incorporation / Formation Date:
FEIN:	270277771-1
Ohio License Number:	39897
NPN:
DBA / Trade Name:	HEALTHMARKETS INSURANCE AGENCY
State of Domicile:	TX
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
ADAM SANTOS	PRODUCER	17010138	YES		05/21/2018
BRITTANY OLIVER	PRODUCER	17554531	YES		05/21/2018
DANIEL SCHRADER	PRODUCER	18769269	YES		05/21/2018
DENISE BLACK	PRODUCER	17610218	YES		05/21/2018
DONALD WALTON	PRODUCER	78756208	YES		05/21/2018
HERBERT BAUMGARTEN	PRODUCER	18341126	YES		05/21/2018
JOSHUA STEPHENS	PRODUCER	17961920	YES		05/21/2018
KELLY MCGARRY	PRODUCER	18752644	YES		05/21/2018
NICOLA ALSTON	PRODUCER	17232846	YES		05/21/2018
PERETZ WERTENTEIL	PRODUCER	7344903	YES		05/21/2018
ROBERT MORGEN	PRODUCER	17402380	YES		05/21/2018
TODD TITSWORTH	PRODUCER	992588	YES		05/21/2018
WILLIAM MARSDEN	PRODUCER	18766079	YES		05/21/2018

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