Notification of Changes for Business Entity
General Information
Business Entity Name:	MEDICARE SOLUTIONS
Incorporation / Formation Date:
FEIN:	45-0545685
Ohio License Number:	37385
NPN:	10312329
DBA / Trade Name:
State of Domicile:	OH
County:	MONTGOMERY
Business Address
Address 1:	6401 HIDDEN HILLS DR.
Address 2:
City:	CENTERVILLE
State:	OH
Zip:	45459
Phone:	9377508711
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	6401 HIDDEN HILLS DR.
Address 2:
City:	CENTERVILLE
State:	OH
Zip:	45459
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
SCOTT M LOMBARDO	OWNER	1463217		YES
SCOTT M LOMBARDO	RDA	1463217		YES
SCOTT M LOMBARDO	DIRECTOR	1463217		YES
ALEXANDRA EDWARDS	RDA	17779595	YES		1/19/18

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:	CHRISTY WASHINGTON
Title:	OFFICE MANAGER
Phone Number:	9377508711
Email Address:	CWASHINGTON@MEDICARESOLUTIONS.INFO