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
LARRY ERICKSON	AGENT	17700381	YES		01/27/2016
GREG FITZPATRICK	AGENT	1866439	YES		01/27/2016
MYESHIA FOREMAN	AGENT	9674716	YES		01/27/2016
KATHLEEN FRANKS	AGENT	16777164	YES		01/27/2016
CATHERINE GALLAGHER	AGENT	3141650	YES		01/27/2016
KAYLA GREEN	AGENT	17698820	YES		01/27/2016
OLIVIA HALLAS	AGENT	17288709	YES		01/27/2016
DORIS HARDY	AGENT	1849425	YES		01/27/2016
STACEY LEIGH HARRIS	AGENT	17648585	YES		01/27/2016
LASTTINA HILL	AGENT	16694962	YES		01/27/2016
MERCIA HILL	AGENT	17638330	YES		01/27/2016
PAWNEE HOLLAND	AGENT	17708319	YES		01/27/2016
JAMIE INGOLD	AGENT	17049728	YES		01/27/2016
PATRICIA JARVIS	AGENT	15842512	YES		01/27/2016
COURTNEY JETER	AGENT	17706674	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