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
MAKALA PRUITT	AGENT	17587362	YES		01/27/2016
MATTHEW PURSLEY	AGENT	17058259	YES		01/27/2016
LATOYA RAYE	AGENT	17615931	YES		01/27/2016
ANDREW REAM	AGENT	1772593	YES		01/27/2016
SHARI ROSE	AGENT	17296097	YES		01/27/2016
SHARDAE RUFFIN	AGENT	17182524	YES		01/27/2016
RUBEN RYAN	AGENT	17383708	YES		01/27/2016
FRANCES SHARTZER	AGENT	17394128	YES		01/27/2016
STEPHANIE A SHEPPER	AGENT	17697747	YES		01/27/2016
RANDALL SHORE	AGENT	15365178	YES		01/27/2016
NESTOR SILVA	AGENT	17702947	YES		01/27/2016
MICHAEL SIMMS	AGENT	17415881	YES		01/27/2016
VENITA SMALLS	AGENT	17741480	YES		01/27/2016
KEYAIRA SMITH	AGENT	15186420	YES		01/27/2016
BARBARA STANTON	AGENT	16339714	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