Notification of Changes for Business Entity
General Information
Business Entity Name:	AMERICAN THERAPY ADMINISTATORS, LLC
Incorporation / Formation Date:	8/28/1998
FEIN:	39-1938014
Ohio License Number:	1018146
NPN:
DBA / Trade Name:
State of Domicile:	WI
County:	WAUKESHA
Business Address
Address 1:	N92W14612 ANTHONY AVE.
Address 2:
City:	MENOMONEE FALLS
State:	WI
Zip:	53051
Phone:	262-834-6130
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	W140N8981 LILLY RD
Address 2:
City:	MENOMONEE FALLS
State:	WI
Zip:	53051
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
LISA A. SWEENEY	CFO	397787266	YES		4/24/2017
JAMES P. PURKO	CFO	387702285		YES	4/24/2017

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:	DAVID W. DINGLEY
Title:	PRESIDENT
Phone Number:	262-834-6130
Email Address:	LICENSING@SKYGENUSA.COM