Notification of Changes for Business Entity
General Information
Business Entity Name:	SPRING MEDICARE EXCHANGE, LLC
Incorporation / Formation Date:
FEIN:	80-0961787
Ohio License Number:	1013370
NPN:	17132171
DBA / Trade Name:
State of Domicile:	MO
County:	JACKSON
Business Address
Address 1:	2301 MCGEE ST. STE. 400
Address 2:
City:	KANSAS CITY
State:	MO
Zip:	64108
Phone:	913-333-3940
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2301 MCGEE ST. STE. 400
Address 2:
City:	KANSAS CITY
State:	MO
Zip:	64108
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	YES	New DBA/Trade Name:	SPRING HEALTH PLANS
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)	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:	CASEY HONEYWELL
Title:	COMPLIANCE MANAGER
Phone Number:	913-333-3940
Email Address:	LICENSING@SPRINGHEALTHPLANS.COM