Notification of Changes for Business Entity
General Information
Business Entity Name:	TRUBRIDGE, INC
Incorporation / Formation Date:	08/07/2008
FEIN:	260641675
Ohio License Number:	1022490
NPN:	12780560
DBA / Trade Name:
State of Domicile:	OH
County:	STARK
Business Address
Address 1:	219 E MAPLE STREET
Address 2:	SUITE 3000
City:	NORTH CANTON
State:	OH
Zip:	44720
Phone:	3304913110
Fax:	3304913123
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
GERRAD KESLING	AGENT	17638319	YES		01/27/2016
BARRY LANDWERT	AGENT	17394402	YES		01/27/2016
HANORA LAPPING	AGENT	17291038	YES		01/27/2016
IDA LENNON	AGENT	9146045	YES		01/27/2016
CHARLES MASON	AGENT	8997228	YES		01/27/2016
STEPHANIE ANN MAYLE	AGENT	17698797	YES		01/27/2016
ALISHA MCCRAY	AGENT	17065405	YES		01/27/2016
BARBARA MILLER	AGENT	16593699	YES		01/27/2016
BRENNA MOLLOY	AGENT	17811497	YES		01/27/2016
SPENCER MONTE	AGENT	17604124	YES		01/27/2016
VICTORIA NEAL	AGENT	16595115	YES		01/27/2016
STEVE NORRIS	AGENT	16777203	YES		01/27/2016
ANDREA NOTTINGHAM	AGENT	17177313	YES		01/27/2016
BRETT PHILLIPPI	AGENT	1767244	YES		01/27/2016
CARLA PROUDFOOT	AGENT	17703894	YES		01/27/2016

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:	CINDY MOLESKY
Title:	LICENSING/CONTRACTING SUPERVISOR
Phone Number:	3304913110
Email Address:	LICENSING@TRUBRIDGEINC.COM