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
CAROLINA MILES	AGENT	799096	YES		8/30/2016
ERICA VELASQUEZ MORALES	AGENT	1112404	YES		8/30/2016
STEVEN COLEMAN MOTT	AGENT	964254	YES		8/30/2016
SEAN RICHARD MOURA	AGENT	1117978	YES		8/30/2016
TONYA LYNN MURDOCK	AGENT	942144	YES		8/30/2016
JACK NAIDU	AGENT	997973	YES		8/30/2016
APRIL SUMMER NANCE	AGENT	804238	YES		8/30/2016
TUESDAY NOLDEN	AGENT	968599	YES		8/30/2016
JAMES DAVID O BRIEN III	AGENT	963547	YES		8/30/2016
JUSTIN O DONNELL	AGENT	1086947	YES		8/30/2016
RICHARD LOUIS O LEARY	AGENT	997871	YES		8/30/2016
DONALD JAY PERLSTEIN	AGENT	1117971	YES		8/30/2016
KRISTINA PERRI	AGENT	1068279	YES		8/30/2016
TREVOR ORLANDO PITTS	AGENT	1116069	YES		8/30/2016
JASMINE RODNESHASHADE PRICE	AGENT	1111199	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 VINOSN
Title:	LICENSING ASSISTANT
Phone Number:	916-608-6183
Email Address:	LICENSING@EHEALTHINSURANCE.COM