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
SHAWN M WAERS	AGENT	18100267		YES	03/03/2017
SHERYL B DETTWEILER	AGENT	18008546		YES	03/03/2017
STASHIA L NOLAND	AGENT	18042306		YES	03/03/2017
STEPHANIE A SHEPPER	AGENT	17697747		YES	03/03/2017
STEVEN ARTHUR ROBINSON	AGENT	6624598		YES	03/03/2017
TALESHA LASHAY JOHNSON	AGENT	17697739		YES	03/03/2017
TISHA N LYNN	AGENT	18011309		YES	03/03/2017
TRAVIS M MASTERS	AGENT	18102767		YES	03/03/2017
LACEY DYER	AGENT	17389407	YES		03/03/2017
LIZA COLSON	AGENT	18330315	YES		03/03/2017
EMMANUEL FELLOUZIS	AGENT	18316216	YES		03/03/2017
CHARLES INBODEN	AGENT	18316150	YES		03/03/2017
KASSANDRA JAFFE	AGENT	18330308	YES		03/03/2017
RACHEL MCDONALD	AGENT	18330446	YES		03/03/2017
CHANDRA ROBINSON	AGENT	17011678	YES		03/03/2017

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
ALAINA SCHOCK	AGENT	18330357	YES		03/03/17
JACOB TURBEVILLE	AGENT	18317791	YES		03/03/17

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 COORDINATOR
Phone Number:	3304913110
Email Address:	LICENSING@TRUBRIDGEINC.COM