Notification of Changes for Business Entity
General Information  
Business Entity Name: INSPHERE INSURANCE SOLUTIONS
Incorporation / Formation Date:  
FEIN: 27-027777-1
Ohio License Number: 39897
NPN: 14412207
DBA / Trade Name: HEALTHMARKETS INSURANCE AGENCY
State of Domicile: DE
County: TARRANT
Business Address  
Address 1: 9151 BOULEVARD 26
Address 2:  
City: NORTH RICHLAND HILLS
State: TX
Zip: 76180
Phone: 817-255-3454
Fax:  
Business Web Site Address:  
Business Email Address: ONBOARDING@HEALTHMARKETSHQ.COM
Mailing Address  
Address 1: 9151 BOULEVARD 26
Address 2:  
City: NORTH RICHLAND HILLS
State: TX
Zip: 76180
   
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: NO
   
Licensed Producers
Name Title NPN Add Delete Eff. Date
BRANDON BUTLER PRODUCER 17496262 YES   03/27/2018
FABIO RECINE PRODUCER 18372064 YES   03/27/2018
JUSTIN GREENUP PRODUCER 18711562 YES   03/27/2018
LESLIE GOULD SR PRODUCER 1840144 YES   03/27/2018
MICHAEL LOVELACE PRODUCER 17187934 YES   03/27/2018
MICHAEL MILLER PRODUCER 18568289 YES   03/27/2018
OURIEL DZIKOWSKI PRODUCER 17239026 YES   03/27/2018
ROBERT HARGER PRODUCER 17627074 YES   03/27/2018
RONNETTE FISHER PRODUCER 16617333 YES   03/27/2018
           
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) 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: JAMES C MASON
Title: SR VICE PRESIDENT
Phone Number: 817-255-3454
Email Address: ONBOARDING@HEALTHMARKETSHQ.COM