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
AMY STEMPLE	AGENT	17700332	YES		01/27/2016
TANYA STOUT	AGENT	17179367	YES		01/27/2016
HOLLY STUBBINS	AGENT	17730778	YES		01/27/2016
BRANDON THOMPSON	AGENT	17379702	YES		01/27/2016
DOUGLAS URBAN	AGENT	17181552	YES		01/27/2016
LATOYA WASHINGTON	AGENT	17696594	YES		01/27/2016
MARK WATERS	AGENT	17700352	YES		01/27/2016
ERICA WHEELER	AGENT	16971660	YES		01/27/2016
JORDAN WILLIAMS	AGENT	17032280	YES		01/27/2016
DESTANI WINN	AGENT	17389337	YES		01/27/2016
STACY ZSIGRAY	AGENT	17720044	YES		01/27/2016
CHRISTOPHER BANKS	AGENT	17019225	YES		01/27/2016
CHRISTINA DAVIS	AGENT	17672105	YES		01/27/2016
RHEA DOBLAR	AGENT	16804769	YES		01/27/2016
TARA EREMICH	AGENT	17034279	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