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
ISRONNA FRANKS	AGENT	17739471	YES		01/27/2016
DANIEL J HANCOCK	AGENT	17697736	YES		01/27/2016
KATELYN HAREN	AGENT	16778091	YES		01/27/2016
RYAN HARRIS	AGENT	16405863	YES		01/27/2016
KIMBERLY HAWKINS	AGENT	17051013	YES		01/27/2016
DAEMON HAYES	AGENT	16976917	YES		01/27/2016
SIOBHAN HOUSEHOLDER	AGENT	17728324	YES		01/27/2016
DUSTIN JONES	AGENT	17650467	YES		01/27/2016
JEROME JONES	AGENT	17706872	YES		01/27/2016
JUSTINA LIDDERDALE	AGENT	17186025	YES		01/27/2016
AMANDA LUPI	AGENT	16779141	YES		01/27/2016
AMBER MAJEWSKI	AGENT	17757421	YES		01/27/2016
MEGHAN ROBINSON	AGENT	17693790	YES		01/27/2016
CYNTHIA MCNAIR	AGENT	6601228	YES		01/27/2016
VALERIE MILLER	AGENT	17019253	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