Notification of Changes for Business Entity
General Information
Business Entity Name:	EHEALTHINSURANCE SERVICES, INC
Incorporation / Formation Date:	11/14/1997
FEIN:	770470789
Ohio License Number:	25097
NPN:	2971515
DBA / Trade Name:
State of Domicile:	CA
County:	SACRAMENTO
Business Address
Address 1:	11919 FOUNDATION PLACE
Address 2:	#100
City:	GOLD RIVER
State:	CA
Zip:	95670
Phone:	9166086183
Fax:	9166086141
Business Web Site Address:
Business Email Address:	LICENSING@EHEALTHINSURANCE.COM
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
NEETU SINGH	AGENT	799840		YES	8/30/2016
PATRICIA MARIE HERNANDEZ	AGENT	1084898		YES	8/30/2016
PHILIP JAMES DAVIS	AGENT	1075550		YES	8/30/2016
PIERCE CHARLES SMITH	AGENT	1067344		YES	8/30/2016
RANDALL L WAGERS	AGENT	1033120		YES	8/30/2016
RANDY G MERRICK	AGENT	1046485		YES	8/30/2016
RICHARD ANTHONY ROBERTS	AGENT	1006225		YES	8/30/2016
STEPHEN KYLE SCHWARTZ	AGENT	988648		YES	8/30/2016
STEVEN DEE PUGMIRE	AGENT	996105		YES	8/30/2016
SYDNEY NESLEN	AGENT	1070644		YES	8/30/2016
TERESA MARIA PERRY	AGENT	1067140		YES	8/30/2016
THOMAS C SNYDER	AGENT	970864		YES	8/30/2016
TRACEY JACKSON	AGENT	996821		YES	8/30/2016
TROY ALLAN ATTANASIO	AGENT	822669		YES	8/30/2016
TY RUSSELL	AGENT	1030514		YES	8/30/2016

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)
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:	SARAH VINSON
Title:	LICENSING ASSISTANT
Phone Number:	916-608-6183
Email Address:	LICENSING@EHEALTHINSURANCE.COM