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
JOVITA BAKER	AGENT	17376085	YES		01/27/2016
JEANINE BLATE	AGENT	17392073	YES		01/27/2016
NICOLE BOOTH	AGENT	17177381	YES		01/27/2016
NICHOLAS BOY	AGENT	16807280	YES		01/27/2016
SHARON M BREEN	AGENT	17700202	YES		01/27/2016
BRIANNA N BROOKS	AGENT	17727015	YES		01/27/2016
JAMES BURNS	AGENT	1803447	YES		01/27/2016
BRYSON BUSH	AGENT	17696533	YES		01/27/2016
JOSEPH CARBONE	AGENT	16414735	YES		01/27/2016
TROY CONLEY	AGENT	17176447	YES		01/27/2016
MAXIE CRESS	AGENT	17730661	YES		01/27/2016
JASON DAUGHERTY	AGENT	16793081	YES		01/27/2016
MICHAEL DOYLE	AGENT	16977078	YES		01/27/2016
DANIELLE DUPLER	AGENT	17186034	YES		01/27/2016
JAMES EDWARDS	AGENT	16709197	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