Notification of Changes for Business Entity
General Information
Business Entity Name:	GEMGROUP, INC.
Incorporation / Formation Date:
FEIN:	26-1603738
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	PA
County:	ALLEGHENY
Business Address
Address 1:	THREE GATEWAY CENTER
Address 2:	401 LIBERTY AVE., SUITE 1200
City:	PITTSBURGH
State:	PA
Zip:	15222
Phone:	813-1289-1000
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	JEFF BELL
Address 2:	3501 FRONTAGE RD
City:	TAMPA
State:	FL
Zip:	33607
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
STEVEN V. HULSLANDER	PRODUCER	258853		YES	1/25/16
DAVID HOLTON	PRODUCER	16608604		YES	1/25/16
THOMAS D. SCIUTO	PRODUCER	402138	YES		1/25/16

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)
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:	ARTHUR T. SCHULTZ
Title:	PRESIDENT
Phone Number:	813-289-1000
Email Address:	JBELL@HEALTHPLAN.COM