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:	CA
County:	SACRAMENTO
Business Address
Address 1:	11919 FOUNDATION PLACE, SUITE 100
Address 2:
City:	SACRAMENTO
State:	CA
Zip:	95670
Phone:	9166086165
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	11919 FOUNDATION PLACE, SUITE 100
Address 2:
City:	SACRAMENTO
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
AADIL, MARNETT AIDA	AGENT	18492885	YES		10-20-17
BARRIGA, ANGELICA ALFARO	AGENT	8963736	YES		10-20-17
CANNADAY, NICHOLAS A	AGENT	18297002	YES		10-20-17
CHAVEZ, REYNA DOLORES	AGENT	18450488	YES		10-20-17
EDWARDS, DARNISE MARIE	AGENT	10204841	YES		10-20-17
ESPINO, MATTHEW E	AGENT	18337791	YES		10-20-17
HALL, JOY MARIE	AGENT	8439122	YES		10-20-17
HARDING, ROBERT BRETT	AGENT	16699535	YES		10-20-17
HOLTRICHTER, PETER CHARLES	AGENT	3428932	YES		10-20-17
MURNANE, RYAN P	AGENT	18295726	YES		10-20-17
POWELL, MARIAH	AGENT	18354148	YES		10-20-17
RECINOS, ERICA	AGENT	17438508	YES		10-20-17
TURNER, FRED	AGENT	18531093	YES		10-20-17

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:	KATHY LONG-TURNER
Title:	LICENSING ASSISTANT
Phone Number:	9166086165
Email Address:	LICENSING@EHEALTHINSURANCE.COM