Notification of Changes for Business Entity
General Information
Business Entity Name:	EHEALTH INSURANCE
Incorporation / Formation Date:
FEIN:	77-0470789
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	CA
County:	SACRAMENTO
Business Address
Address 1:	11919 FOUNDATION PLACE, SUITE 100
Address 2:
City:	GOLD RIVER
State:	CA
Zip:	95670
Phone:	800-299-3116
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	11919 FOUNDATION PLACE, SUITE 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
ZACHARY ROTH	MAJOR LINES	17982143		YES	05/02/18
ROBERT SARAIVA	MAJOR LINES	18060868		YES	05/02/18
WESLEY SHEPELUK	MAJOR LINES	9873359		YES	05/02/18
KATINKA STENIUS	MAJOR LINES	17389215		YES	05/02/18
GEORGE THORLIN	MAJOR LINES	17607870		YES	05/02/18
MAURICE T THORPE	MAJOR LINES	12624041		YES	05/02/18
LESTER WHITE	MAJOR LINES	18060885		YES	05/02/18
JAMES J WILHELM	MAJOR LINES	16393155		YES	05/02/18
DUSTIN WONG	MAJOR LINES	16905770		YES	05/02/18
ERIC J YOUNG	MAJOR LINES	7918333		YES	05/02/18
ADRIANA E ANDERSON	MAJOR LINES	12766769		YES	05/02/18
ANTHONY CHARLES CONSTAS	MAJOR LINES	8792340		YES	05/02/18
WILLIAM CORA JR.	MAJOR LINES	17369333		YES	05/02/18
RICHARD LOUIS O'LEARY	MAJOR LINES	807159		YES	05/02/18
CHRISTINE MARIE PENNEY	MAJOR LINES	2543552		YES	05/02/18

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:	ESTY NGUYEN
Title:	LICENSING ASSISTANT
Phone Number:	801-562-4051
Email Address:	LICENSING@EHEALTHINSURANCE.COM