Notification of Changes for Business Entity
General Information  
Business Entity Name: BMS INTERMEDIARIES INC
Incorporation / Formation Date:  
FEIN: 752857254
Ohio License Number:
NPN:
DBA / Trade Name:  
State of Domicile: MN
County: HENNEPIN
Business Address  
Address 1: 7650 EDINBOROUGH WAY, SUITE 600
Address 2:  
City: EDINA
State: MN
Zip: 55435
Phone: 952.224.0200
Fax:  
Business Web Site Address:  
Business Email Address:  
Mailing Address  
Address 1: 7650 EDINBOROUGH WAY, SUITE 600
Address 2:  
City: EDINA
State: MN
Zip: 55435
   
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
DAWNMARIE BLACK SVP 202-64-8548 YES   01/01/2017
JAMES BOTSIS SVP 319-78-8516 YES   01/01/2017
ROMULO BRAGA SVP 229-83-1572 YES   01/01/2017
CHRISTA FAUSTMAN SVP 177-70-6939 YES   01/01/2017
FRANK HERNANDEZ, JR. SVP 051-54-1509 YES   01/01/2017
JOHN MATTHEW HICKEY SVP 112-58-5897 YES   01/01/2017
BRANDON HOPKINS SVP 471-06-7234 YES   01/01/2017
JASON LIMBER SVP 303-21-3679 YES   01/01/2017
CHRISTOPHER SEAN MCCRARY SVP 446-97-3408 YES   01/01/2017
SEAN MCDERMOTT SVP 046-70-0868 YES   01/01/2017
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 N/A
Submitted By  
Submitted By: STEPHANIE STEEL
Title: RISK AND COMPLIANCE MANAGER
Phone Number: 952.224.0200
Email Address: CHILL@ARCLICENSING.COM