Notification of Changes for Business Entity
General Information
Business Entity Name:	ALICARE, INC.
Incorporation / Formation Date:
FEIN:	13-3432221
Ohio License Number:	34316 (BUSINESS ENTITY) & 36821 (TPA)
NPN:	2225570
DBA / Trade Name:
State of Domicile:	NY
County:	WESTCHESTER
Business Address
Address 1:	333 WESTCHESTER AVENUE
Address 2:
City:	WHITE PLAINS
State:	NY
Zip:	10604
Phone:	914-367-5581
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	333 WESTCHESTER AVENUE
Address 2:
City:	WHITE PLAINS
State:	NY
Zip:	10604
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
RICHARD DOWNEY	ASSISTANT VP	9780179		YES	10/12/15
GRACE SEALY-CURTIS	ASSISTANT VP	7520031		YES	1/1/15
MELANIE CANNON	ASSISTANT VP	326257	YES		10/12/115

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:	DIANE PAPPAS FOR ELLEN R. DUNKIN, SR. VP
Title:	COMPLIANCE MANAGER
Phone Number:	914-367-5581
Email Address:	DPAPPAS@AMALGAMATEDLIFE.COM