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
RICHARD JOHN ZYTKA	AGENT	2280079		YES	01/27/2016
WILLIAM H CARR	AGENT	1856311		YES	01/27/2016
SARA MICHELE CRUSADE	AGENT	5689515		YES	01/27/2016
SHELLY DRISCOLL	AGENT	8792479		YES	01/27/2016
STEPHEN C MALCOLM	AGENT	2825088		YES	01/27/2016
TERESA ANDERSON ALBERT	AGENT	17746448	YES		01/27/2016
MARGO BAIR	AGENT	17642251	YES		01/27/2016
MELANIE BAKER	AGENT	17616097	YES		01/27/2016
MASHELLE BARKER	AGENT	16801226	YES		01/27/2016
COURTNEY BASKIN	AGENT	16809981	YES		01/27/2016
DANIELLE BRADY	AGENT	17725507	YES		01/27/2016
TAMMY CARRICO	AGENT	17375620	YES		01/27/2016
LISA DALTON	AGENT	17702980	YES		01/27/2016
RHONDA DAVIS	AGENT	17288647	YES		01/27/2016
CARLENE DURICEK	AGENT	17041006	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