Notification of Changes for Business Entity
General Information
Business Entity Name:	EHEALTH INSURANCE
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:	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
BRENDA M ABRAHAMS	MAJOR LINES	10156753		YES	05/02/18
E JOHN ALNER	MAJOR LINES	5410084		YES	05/02/18
KATHLEEN AUBLE	MAJOR LINES	17982142		YES	05/02/18
MARGRETE J BAILEY	MAJOR LINES	9544454		YES	05/02/18
RICHARD EDWARD BENOIT	MAJOR LINES	2312226		YES	05/02/18
CASSANDRA BICCHIERI	MAJOR LINES	18483434		YES	05/02/18
BENJAMIN BLOCH	MAJOR LINES	17683577		YES	05/02/18
DANIEL BRADY	MAJOR LINES	17979743		YES	05/02/18
JOHN A BULLINER	MAJOR LINES	10678387		YES	05/02/18
JOSHUA CABRERA	MAJOR LINES	17870884		YES	05/02/18
JOSHUA CARAS	MAJOR LINES	17989849		YES	05/02/18
JOSEPH CHARON	MAJOR LINES	17870892		YES	05/02/18
JAMES W CONNORS	MAJOR LINES	18338171		YES	05/02/18
LISA CORA	MAJOR LINES	16992911		YES	05/02/18
LEONARDO CRISOSTOMO	MAJOR LINES	16644957		YES	05/02/18

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