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
ADRIANA RADULOVICH	AGENT	743812	YES		8/30/2016
GEORGE RAYNE	AGENT	1067649	YES		8/30/2016
SARAH LOUISE RENDON	AGENT	1116085	YES		8/30/2016
ZACHARY ROME	AGENT	1117985	YES		8/30/2016
OSAMA E SAFA	AGENT	937691	YES		8/30/2016
YUMI SAGARA	AGENT	1067650	YES		8/30/2016
ROBERT SARAIVA	AGENT	1117981	YES		8/30/2016
MATTHEW HARRISON SHELLHAMMER	AGENT	1116409	YES		8/30/2016
WESLEY SHEPELUK	AGENT	1117989	YES		8/30/2016
MICHAEL DAVID SILBER	AGENT	1067658	YES		8/30/2016
CYNTHIA LUCILLE SOLTESZ	AGENT	1110143	YES		8/30/2016
KATINKA STENIUS	AGENT	1117996	YES		8/30/2016
CATHERINE STONE	AGENT	1118012	YES		8/30/2016
EARL CLIFTON STUCKEY III	AGENT	1110390	YES		8/30/2016
MOISES VELEZ	AGENT	1110318	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