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
ALMA LOUISE BENNETT	AGENT	1068444		YES	8/30/2016
ANASEINI TAKIPO CHANDLER	AGENT	767283		YES	8/30/2016
ANDREW EDWARD HORN	AGENT	1032551		YES	8/30/2016
ANGELA KATHLEEN ROCHA	AGENT	799827		YES	8/30/2016
ANH LY	AGENT	1004104		YES	8/30/2016
ANTHONY JAMES GARAY	AGENT	1084911		YES	8/30/2016
ASHLEY BENNETT	AGENT	1038018		YES	8/30/2016
BARBARA CATHERINE LECLERC	AGENT	787158		YES	8/30/2016
BARBARA JEAN BASILE	AGENT	1072873		YES	8/30/2016
BARRETT GORDON-CARROLL	AGENT	1033332		YES	8/30/2016
BENJAMIN SIGMUND BARTH	AGENT	828993		YES	8/30/2016
BRADLEY MICHAEL BAHAN	AGENT	987317		YES	8/30/2016
BRENT THOMPSON	AGENT	1032697		YES	8/30/2016
BREON H HOWE	AGENT	991496		YES	8/30/2016
CAMERON LEE BECKHAM	AGENT	1004145		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 VINSON
Title:	LICENSING ASSISTANT
Phone Number:	916-608-6183
Email Address:	LICENSING@EHEALTHINSURANCE.COM