Notification of Changes for Business Entity
General Information
Business Entity Name:	LONG TERM CARE PARTNERS, LLC
Incorporation / Formation Date:
FEIN:	412029885
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	NH
County:	ROCKINGHAM
Business Address
Address 1:	100 ARBORETUM DRIVE
Address 2:
City:	PORTSMOUTH
State:	NH
Zip:	03801
Phone:	6034334510
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	100 ARBORETUM DRIVE
Address 2:
City:	PORTSMOUTH
State:	NH
Zip:	03801
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
EILEEN CLOHERTY	ASST. VP AND ASST. TREASURER	011605086	YES		3/1/2018
BROOKS TINGLE	MANAGER	002627549	YES		3/1/2018
MITCHELL KARMAN	VICE PRESIDENT	213549789	YES		3/1/2018

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)
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?
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:	PEGGY MURRAY
Title:	SECRETARY
Phone Number:	8562160220
Email Address:	KATIE@WESTMONTLAW.COM