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
SHARINA MONROE	AGENT	17071289	YES		01/27/2016
GARIELLE PALMER	AGENT	17699115	YES		01/27/2016
RICHARD PAPAY	AGENT	1433331	YES		01/27/2016
ALLISON POLLARD	AGENT	17633185	YES		01/27/2016
MARCUS REINART	AGENT	17062251	YES		01/27/2016
CARLA RHINE	AGENT	17081948	YES		01/27/2016
ANNTWANETTE RILEY	AGENT	17697745	YES		01/27/2016
CODY RININGER	AGENT	17701584	YES		01/27/2016
JESSICA ROGERS	AGENT	17709658	YES		01/27/2016
PATRICIA RUFENER	AGENT	17064292	YES		01/27/2016
TIFFANY SHARLOW	AGENT	16984286	YES		01/27/2016
RONALD SHARPE	AGENT	2134891	YES		01/27/2016
JAMES SHEPHERD	AGENT	17704035	YES		01/27/2016
JULIE SHERMAN	AGENT	17038262	YES		01/27/2016
VERONICA SINGLETON	AGENT	17055460	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