Notification of Changes for Business Entity
General Information
Business Entity Name:	TRUBRIDGE INC
Incorporation / Formation Date:
FEIN:	26-0641675
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:	201-552-5816
Fax:
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
FRANKLIN HILL	AGENT	18102640	YES		09/27/16
AMANDA MARTZ	AGENT	17724401	YES		09/27/16
TRAVIS MASTERS	AGENT	18102767	YES		09/27/16
SANDRA MERRITT	AGENT	18098725	YES		09/27/16
RONALD MURREY	AGENT	1731621	YES		09/27/16
LORA OYSTER	AGENT	18091168	YES		09/27/16
DARCY SODERSTROM	AGENT	18102410	YES		09/27/16
DIANE STERLING	AGENT	18098321	YES		09/27/16
AMBER TAYLOR	AGENT	16011545	YES		09/27/16
SHAWN WAERS	AGENT	18100267	YES		09/27/16
BRITTANY ASHBY	AGENT	18061036	YES		09/27/16
JOVITA BAKER	AGENT	17376085	YES		09/27/16
KRISTEN BEITZEL	AGENT	18021046	YES		09/27/16
MATTIE BRANDAL	AGENT	18085037	YES		09/27/16
ALAINA BROWN	AGENT	18086990	YES		09/27/16

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
BRIAN BROWN	AGENT	17952350	YES		09/27/16
AMY BRUCKELMYER	AGENT	18010466	YES		09/27/16
LINDA BRYANT	AGENT	2258803	YES		09/27/16
MARY R BAUMGARDNER	AGENT	18008708	YES		09/27/16
SHA'LEKA CAMERON	AGENT	18082887	YES		09/27/16
RYAN CARLSON	AGENT	17748614	YES		09/27/16
ASHLEY CARRELLI	AGENT	18050812	YES		09/27/16
ALEXANDRA CAVINESS	AGENT	18082931	YES		09/27/16
CAITLIN COMBS	AGENT	18067192	YES		09/27/16
JUSTIN COPE	AGENT	18074184	YES		09/27/16

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 COORDINATOR
Phone Number:	201-552-5816
Email Address:	LICENSING@TRUBRIDGEINC.COM