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:	YES

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
ERIC ARVIN ARTHUR	AGENT	1110483	YES		8/30/2016
HARVEEN SINGH BADESHA	AGENT	1116407	YES		8/30/2016
HANNAH MARIEL BALDWIN	AGENT	1110179	YES		8/30/2016
VANESSA PAULETTA BANKS	AGENT	1111255	YES		8/30/2016
DEREK JOHN BILLOUIN	AGENT	1117863	YES		8/30/2016
NICOLE YVETTE BOLTON	AGENT	1112310	YES		8/30/2016
MATTHEW MICHAEL BOONE	AGENT	1111230	YES		8/30/2016
JILLIAN E BOYNTON	AGENT	1117867	YES		8/30/2016
CHARLANA NICOLE BROWN	AGENT	1116079	YES		8/30/2016
HAYLEY BUMSTEAD	AGENT	1116059	YES		8/30/2016
TARA PHOENIX BURGESS	AGENT	1110165	YES		8/30/2016
GINA GABRIELLE CARLINI	AGENT	760659	YES		8/30/2016
RALPH CERBONE	AGENT	1117870	YES		8/30/2016
MATTHEW DAVID CHANCE	AGENT	1116553	YES		8/30/2016
CRYSTAL ESPERANZA COKER	AGENT	1111351	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