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:	CA
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:	EHEALTHINSURANCE SERVICES, INC
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
JUSTIN JIMENEZ	AGENT	8762375	YES		11/04/2015
MICHAEL LE VIAS	AGENT	6409495	YES		11/04/2015
KIERA LONG	AGENT	8284318	YES		11/04/2015
BRIANNE MILLER	AGENT	17273779	YES		11/04/2015
JAMES NICKERSON	AGENT	17453501	YES		11/04/2015
MANUEL REGI	AGENT	17685664	YES		11/04/2015
EUNICE REID	AGENT	15998019	YES		11/04/2015
NUSHEEN REYKANDEH	AGENT	17029677	YES		11/04/2015
ADAM SALAZAR	AGENT	2643620	YES		11/04/2015
JAMES SWANIGAN	AGENT	17698460	YES		11/04/2015
CHERYL WALLACE	AGENT	2565687	YES		11/04/2015
EVERARDO ZARAGOZA HERNANDEZ	AGENT	7981591	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