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
MELISSA STEVENS	AGENT	16405857	YES		01/27/2016
RYAN THOMPSON	AGENT	17011674	YES		01/27/2016
SARA LYNN TICHENOR	AGENT	17706682	YES		01/27/2016
CESAR VANDERPOOL	AGENT	17635801	YES		01/27/2016
SHIRLEY VARGO	AGENT	16589573	YES		01/27/2016
LILLIAN VILLARD	AGENT	17034423	YES		01/27/2016
JAMES VOLKMOR	AGENT	8780441	YES		01/27/2016
BRET WACKERLY	AGENT	15344164	YES		01/27/2016
BENJAMIN WARNICK	AGENT	17333287	YES		01/27/2016
JASON A WILCOX	AGENT	17616477	YES		01/27/2016
MONA WONG	AGENT	17372153	YES		01/27/2016
ALISHA WRIGHT	AGENT	17372141	YES		01/27/2016
FREDRICK WRIGHT	AGENT	17052282	YES		01/27/2016
BRANDON ALLISON	AGENT	17011677	YES		01/27/2016
TIFFANY BAILEY	AGENT	17696534	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