Notification of Changes for Business Entity
General Information
Business Entity Name:	PREMIER ADMINISTRATIVE SOLUTIONS, INC.
Incorporation / Formation Date:	02/06/1990
FEIN:	592995015
Ohio License Number:	12608
NPN:
DBA / Trade Name:
State of Domicile:	DE
County:	NEW CASTLE
Business Address
Address 1:	13600 ICOT BLVD, BLDG. A
Address 2:
City:	CLEARWATER
State:	FL
Zip:	33760-3703
Phone:	7275651495
Fax:	8888751592
Business Web Site Address:
Business Email Address:	ENTITYMANAGEMENT@CHSAMERICA.COM
Mailing Address
Address 1:	13600 ICOT BLVD, BLDG. A
Address 2:
City:	CLEARWATER
State:	FL
Zip:	33760-3703
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:	DALE F. SCHMIDT
Title:	SECRETARY
Phone Number:	7275651495
Email Address:	ENTITYMANAGEMENT@CHSAMERICA.COM