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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
DAVON SUMSER	AGENT	17672103		YES	04/20/16
JANICE A NEWLON	AGENT	17683813		YES	04/20/16
JEANINE M BLATE	AGENT	17392073		YES	04/20/16
KEYAIRA M SMITH	AGENT	15186420		YES	04/20/16
MARY L. WALLACE	AGENT	1849738		YES	04/20/16
MELISSA STEVENS	AGENT	16405857		YES	04/20/16
MELVYLYN A THOMPSON	AGENT	7563265		YES	04/20/16
NESTOR SILVA	AGENT	17702947		YES	04/20/16
PATRICK HARRIS	AGENT	8141748		YES	04/20/16
RANDAL WILLIAM ANDERSON	AGENT	11199802		YES	04/20/16
VERONICA SINGLETON	AGENT	17055460		YES	04/20/16
JILLIAN EPPERLY	AGENT	10883733	YES		04/20/16
JASMYN GALPERT	AGENT	17898866	YES		04/20/16
CARA GASSMAN	AGENT	17702972	YES		04/20/16
FRANK MARCHESE	AGENT	2775790	YES		04/20/16

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
JENNIFER SNYDER	AGENT	17013357	YES		04/23/16
CYNTHIA STAUBS	AGENT	11199840	YES		04/20/16
ELIZABETH PISINO	AGENT	17726805	YES		04/20/16

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