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
ANDREW LEE HAYMAKER	AGENT	8499225		YES	01/27/2016
BARBARA JANE DAUBERT	AGENT	1706881		YES	01/27/2016
BRIAN T HULL	AGENT	10416920		YES	01/27/2016
BRIAN THOMAS KERR	AGENT	10658349		YES	01/27/2016
CARL EDWARD MORRISON	AGENT	10370823		YES	01/27/2016
DEBORAH HOOVER	AGENT	8959389		YES	01/27/2016
JOHN ANTHONY BULLINER	AGENT	10678387		YES	01/27/2016
KELLY K SMITH	AGENT	1867103		YES	01/27/2016
KENNETH WILLARD MALSKY	AGENT	14775337		YES	01/27/2016
KURT S DAUM	AGENT	2208536		YES	01/27/2016
LISA MARIE DEMESKO	AGENT	8524893		YES	01/27/2016
MARCI LYNN BERNARD	AGENT	15191647		YES	01/27/2016
MARY L WALLACE	AGENT	1849738		YES	01/27/2016
MELVYLYN A THOMPSON	AGENT	7563265		YES	01/27/2016
RANDAL WILLIAM ANDERSON	AGENT	11199802		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