Notification of Changes for Business Entity
General Information
Business Entity Name:	EHEALTHINSURANCE. SERVICES, INC.
Incorporation / Formation Date:
FEIN:	77-0470789
Ohio License Number:	25097
NPN:	2971515
DBA / Trade Name:
State of Domicile:	OH
County:	USA
Business Address
Address 1:	11919 FOUNDATION PLACE, SUTIE 100
Address 2:
City:	GOLD RIVER
State:	CA
Zip:	95670
Phone:	916 608
Fax:
Business Web Site Address:	9166086165
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
ERIC ARTHUR	AGENT	17446218		YES	717/17
ANA FE BALZIZER	AGENT	8173203		YES	7/17/17
JOSEPH CARBO	AGENT	16781715		YES	7/17/17
MATHEW EVAN	AGENT	16781715		YES	7/17/17
MARK FILICE	AGENT	2731898		YES	7/17/17
RACHEL HALVERSTADT	AGENT	2731898		YES	7/17/17
ALEX HAWKINS	AGENT	18092858		YES	7/17/17
STEVEN HIRSCHFELD	AGENT	7280915		YES	7/17/17
LLOYD HOWARD	AGENT	4762645		YES	7/17/17
WILLIAM HUDSPETH	AGENT	17007446		YES	7/17/17
TRACEY JACKSON	AGENT	17403916		YES	7/17/17
TAMARA LAKE	AGENT	18058629		YES	717/17
PAULA LOFTON	AGENT	16461966		YES	7/17/17
PHILLIP MARKOWITZ	AGENT	17680472		YES	7/17/17
LYNN MAXWELL	AGENT	2032712		YES	7/17/17

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
GARY MATALUCCI	VICE PRESIDENT	7964709		YES	7/17/17

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