Notification of Changes for Business Entity
General Information
Business Entity Name:	PRIME THERAPEUTICS LLC
Incorporation / Formation Date:	12/10/2003
FEIN:	260076803
Ohio License Number:	1003053
NPN:
DBA / Trade Name:
State of Domicile:	DE
County:	NEW CASTLE
Business Address
Address 1:	PRIME THERAPEUTICS LLC
Address 2:	2900 AMES CROSSING ROAD
City:	EAGAN
State:	MN
Zip:	55121
Phone:	6127774000
Fax:	8664708807
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2900 AMES CROSSING ROAD
Address 2:
City:	EAGAN
State:	MN
Zip:	55121
Indicate the type of change you are seeking
Address Change:	YES
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

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:	KIMBERLY JEROME
Title:	COMPLIANCE ANALYST
Phone Number:	6127775477
Email Address:	KIMBERLY.JEROME@PRIMETHERAPEUTICS.COM