Notification of Changes for Business Entity
General Information
Business Entity Name:	TRUBRIDGE INC
Incorporation / Formation Date:
FEIN:	26-0641675
Ohio License Number:	1022490
NPN:	12780560
DBA / Trade Name:
State of Domicile:	OH
County:	STARK
Business Address
Address 1:	219 E MAPLE ST
Address 2:	SUITE 3000
City:	NORTH CANTON
State:	OH
Zip:	44720
Phone:	3304913110
Fax:
Business Web Site Address:
Business Email Address:	LICENSING@TRUBRIDGEINC.COM
Mailing Address
Address 1:	219 E MAPLE ST
Address 2:	SUITE 3000
City:	NORTH CANTON
State:	OH
Zip:	44720
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
ANDREA NOTTINGHAM	AGENT	17177313		YES	03/30/2016
BRYSON J BUSH	AGENT	17696533		YES	03/30/2016
CHRISTINA DANIELLE DAVIS	AGENT	17672105		YES	03/30/2016
CODY M MULHALL	AGENT	11875477		YES	03/30/2016
CODY M RININGER	AGENT	17701584		YES	03/30/2016
JOSHUA RAY EVANS	AGENT	16970462		YES	03/30/2016
KEVIN SCHEID	AGENT	17474134		YES	03/30/2016
LORI EILEEN ESTENIK	AGENT	17668979		YES	03/30/2016
NICHOLAS L MCDANIEL	AGENT	17693133		YES	03/30/2016
SHARON M BREEN	AGENT	17700202		YES	03/30/2016
PATRICK HARRIS	AGENT	8141748	YES		03/30/2016
RHONDA JACKSON	AGENT	11015493	YES		03/30/2016

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:
Title:
Phone Number:	330-491-3110
Email Address:	LICENSING@TRUBRIDGEINC.COM