Notification of Changes for Business Entity
General Information
Business Entity Name:	TRUBRIDGE INC
Incorporation / Formation Date:
FEIN:	260641675
Ohio License Number:
NPN:
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:	3304913130
Fax:
Business Web Site Address:
Business Email Address:
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
KIMBERLY DOTSON	AGENT	17051013		YES	2/21/2018
RACHEL EWING	AGENT	18330446		YES	2/21/2018
DORIS HARDING	AGENT	1849425		YES	2/21/2018
MERCIA HILL	AGENT	17638330		YES	2/21/2018
RHONDA JACKSON	AGENT	11015493		YES	2/21/2018
HANORA LAPPING	AGENT	17291038		YES	2/21/2018
IDA LENNON	AGENT	9146045		YES	2/21/2018
SANDRA MERRITT	AGENT	18098725		YES	2/21/2018
GEORGE MILNES	AGENT	18011248		YES	2/21/2018
ANDREW VARGO	AGENT	18074328		YES	2/21/2018
MELBA WILLIAMS	AGENT	18042293		YES	2/21/2018
BRITTANY ASHBY	AGENT	18061036		YES	2/21/2018
CHERYL HARLOW	AGENT	18008348		YES	2/21/2018
KASSANDRA JAFFE	AGENT	18330308		YES	2/21/2018
EMILY SWING	AGENT	18016986		YES	2/21/2018

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:	NICOLE GATES
Title:	LICENSING SPECIALIST
Phone Number:	3049293257
Email Address:	LICENSING@TZINSURANCE.COM