Notification of Changes for Business Entity
General Information
Business Entity Name:	SCHOOL CLAIMS SERVICES LLC
Incorporation / Formation Date:	05/28/1998
FEIN:	25-1804841
Ohio License Number:	36716
NPN:	3250975
DBA / Trade Name:
State of Domicile:	PA
County:	CUMBERLAND
Business Address
Address 1:	400 BENT CREEK BLVD SUITE 50
Address 2:
City:	MECHANICSBURG
State:	PA
Zip:	17050
Phone:	866-401-6600
Fax:	866-401-6601
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	P.O. BOX 811
Address 2:
City:	NEW CUMBERLAND
State:	PA
Zip:	17070
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:	YES

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
MARK B MILLER	BOARD MEMBER	9004	YES		01/01/2016
WILLIAM S. LACOFF	BOARD MEMBER	5173		YES	12/31/2015
MARIANNE L NEEL	BOARD MEMBER	5263		YES	12/31/2015

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:	ROY E JACOBS III
Title:	PRESIDENT
Phone Number:	717-590-8008
Email Address:	ROY.JACOBS@PSBA.ORG