Notification of Changes for Business Entity
General Information
Business Entity Name:	EHEALTHINSURANCE SERVICES, INC.
Incorporation / Formation Date:
FEIN:	77-0470789
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
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
ERIKA BUENO	MAJOR LINES	18864357		YES	11/02/2018
DANIEL CALDWELL	MAJOR LINES	17858690		YES	11/02/2018
SHAWN CARTER	MAJOR LINES	18810009		YES	11/02/2018
RYAN CASTAGNO	MAJOR LINES	17694265		YES	11/02/2018
DAVID C COOK	MAJOR LINES	18436121		YES	11/02/2018
JEREMY BENJAMIN COSTA	MAJOR LINES	16513741		YES	11/02/2018
JORY DANIEL CROSS	MAJOR LINES	16602108		YES	11/02/2018
DARNISE EDWARDS	MAJOR LINES	10204841		YES	11/02/2018
BRIAN DAVID KAMERATH	MAJOR LINES	18513957		YES	11/02/2018
DUSTIN LARSEN	MAJOR LINES	18863072		YES	11/02/2018
DONALD PAUL PARRY	MAJOR LINES	17403565		YES	11/02/2018
TANJA K POSADA	MAJOR LINES	18863082		YES	11/02/2018
NICHOLAS STEVEN ROBERTS	MAJOR LINES	18806372		YES	11/02/2018
AARON CODY ROGERS	MAJOR LINES	18812636		YES	11/02/2018

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 ADMINISTRATOR
Phone Number:	801-562-4051
Email Address:	LICENSING@EHEALTHINSURANCE.COM