Notification of Changes for Business Entity
General Information
Business Entity Name:	EBIX HEALTH ADMINISTRATION EXCHANGE, INC
Incorporation / Formation Date:
FEIN:	35-1640589
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	IN
County:	ALLEN
Business Address
Address 1:	10315 DAWSON CREEK BLVD
Address 2:	UNIT J
City:	FORT WAYNE
State:	IN
Zip:	46825
Phone:	602-870-1400
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2101 W PEORIA AVE
Address 2:	STE 100
City:	PHOENIX
State:	AZ
Zip:	85029
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

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
TERESA HERBERT	DIRECTOR	152-58-4483	YES		9/9/2015
JAMES SENGE	DIRECTOR	185-52-6576	YES		9/9/2015
ROBIN RAINA	DIRECTOR	613-94-9953	YES		9/9/2015

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:	PETER WIRSKI
Title:	CEO
Phone Number:	602-906-6391
Email Address:	WENDY.PLUMMER@IHCGROUP.COM