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
ALEXANDER DEVUS	AGENT	1152209	YES		2/21/2018
AMIE HORNING	AGENT	18496311	YES		2/21/2018
ANDREA KNIGHT	AGENT	18536558	YES		2/21/2018
ANGELA RUSSICK	AGENT	18496267	YES		2/21/2018
ANNETTA EGLER	AGENT	18450348	YES		2/21/2018
ASHLEY WOODS	AGENT	18513025	YES		2/21/2018
ASHTON CROOKS	AGENT	18427392	YES		2/21/2018
BRANDY DILLON	AGENT	16976911	YES		2/21/2018
CHRISTOPHER SHINN	AGENT	17064293	YES		2/21/2018
CORKISHA PLEDGURE	AGENT	18465104	YES		2/21/2018
DORIS MOSELEY	AGENT	1821167	YES		2/21/2018
ELAINA STROUD	AGENT	18512843	YES		2/21/2018
ERIC KRANNICH	AGENT	18452195	YES		2/21/2018
HAILEE ROWLEY	AGENT	18526795	YES		2/21/2018
JACOB GAMA	AGENT	18286909	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