Notification of Changes for Business Entity
General Information
Business Entity Name:	EHEALTHINSURANCE SERVICES, INC.
Incorporation / Formation Date:
FEIN:	7-0470789
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
CHRISTOPHER MALONSON	AGENT	17418273	YES		11/04/2015
MARISSA PEREA	AGENT	9050581	YES		11/04/2015
STEVEN REES	AGENT	16510572	YES		11/04/2015
NAELA TOTAH	AGENT	17670337	YES		11/04/2015
DAVID TRAWICK	AGENT	17651184	YES		11/04/2015
ADRIAN TRUJILLO	AGENT	7656739	YES		11/04/2015
RICHARD WESTERVELT	AGENT	12862574	YES		11/04/2015
KENNETH WRIGHT	AGENT	17667297	YES		11/04/2015
RYAN ANIDO	AGENT	3983416	YES		11/04/2015
NATHANIEL BWELANT	AGENT	17224681	YES		11/04/2015
FRANK CARRION	AGENT	17249405	YES		11/04/2015
BARBARA FLOVIN	AGENT	17685764	YES		11/04/2015
CHRISTINE HALL	AGENT	13537649	YES		11/04/2015
JEFFREY HENRICHS	AGENT	2660064	YES		11/04/2015
JEFFREY HICKS	AGENT	8640168	YES		11/04/2015

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:	9166086183
Email Address:	LICENSING@EHEALTHINSURANCE.COM