Notification of Changes for Business Entity
General Information
Business Entity Name:	EHEALTHINSURANCE.COM
Incorporation / Formation Date:
FEIN:	77-0470789
Ohio License Number:	25097
NPN:
DBA / Trade Name:
State of Domicile:	CA
County:	SACRAMENTO
Business Address
Address 1:	11919 FOUNDATION PLACE, #100
Address 2:
City:	GOLD RIVER
State:	CA
Zip:	95670
Phone:	916-608-6165
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	11919 FOUNDATION PLACE, #100
Address 2:
City:	GOLD RIVER
State:	CA
Zip:	95670
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
ANDERSON MARK, WENDY	AGENT	18247507	YES		10-9-17
COLLUM, JOSHUA	AGENT	18447721	YES		10-9-17
DAVIES, PAGAN N	AGENT	18519312	YES		10-9-17
DAVIS, KEVIN J	AGENT	18489322	YES		10-9-17
HARRINGTON, PRESLEY M	AGENT	18524280	YES		10-9-17
HEPWORTH, VALERIE	AGENT	18495424	YES		10-9-17
LAMPLUGH, RACHEL L	AGENT	18519337	YES		10-9-17
MACKAY, RACHEL JO	AGENT	16752962	YES		10-9-17
MARTINEAU, TYLER DAN	AGENT	17199868	YES		10-9-17
MCCONNER, RACHALE L	AGENT	18519335	YES		10-9-17
PLANER, SEAN L	AGENT	18525614	YES		10-9-17
ROWLEY, PARKER	AGENT	18503169	YES		10-9-17
RUSSELL, JACOB R	AGENT	18519302	YES		10-9-17
WOLF, KATHERINE LYNN	AGENT	17196012	YES		10-9-17
AKIYAMA, BRETT	AGENT	18495454	YES		10-9-17

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)
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?
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:	KATHY LONG-TURNER
Title:	LICENSING ASSISTANT
Phone Number:	916-608-6165
Email Address:	LICENSING@EHEALTHINSURANCE.COM