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 PL #100
Address 2:
City:	GOLD RIVER
State:	CA
Zip:	95670
Phone:	9166086183
Fax:
Business Web Site Address:
Business Email Address:	LICENSING@EHEALTHINSURANCE.COM
Mailing Address
Address 1:	11919 FOUNDATION PL #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
MATTHEW BRANDON HEDGES	AGENT	17456584	YES		11/08/2016
ANDREA SOMMER CASIANO	AGENT	17892167	YES		11/08/2016
DANIELA ARDELEAN CHAVEZ	AGENT	3983292	YES		11/08/2016
LISA MARY GIANATASIO	AGENT	3407040	YES		11/08/2016
ALEJANDRO GONZALEZ	AGENT	17862400	YES		11/08/2016
TOMAS ANDREW HERNANDEZ	AGENT	18139263	YES		11/08/2016
QIANA LATRICE HILL-ROSS	AGENT	18139239	YES		11/08/2016
MOHANNAD AYYAZ KHAN	AGENT	17857552	YES		11/08/2016
JUAN FERNANDO MALDONADO	AGENT	16978204	YES		11/08/2016
MEGAN SANDRA MILLIKEN	AGENT	18150641	YES		11/08/2016
BRIAN LYLE WAGNER	AGENT	17446081	YES		11/08/2016
JEANINE LOUISE DRAKE	AGENT	8280740	YES		11/08/2016
NATHAN JOSHUA FINE	AGENT	18083751	YES		11/08/2016
OLEA JACKSON	AGENT	18146612	YES		11/08/2016
AMRIT SINGH KANDOLA	AGENT	17872030	YES		11/08/2016

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)	NO
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?	NO
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:	BARBARA CROSS
Title:	LICENSING ASSISTANT
Phone Number:	916-608-6183
Email Address:	LICENSING@EHEALTHINSURANCE.COM