Notification of Changes for Business Entity
General Information
Business Entity Name:	EHEALTHINSURANCE SERVICES, INC.
Incorporation / Formation Date:
FEIN:	770470789
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
NEETU SINGH	AGENT	17081048		YES	09/01/2016
PATRICIA MARIE HERNANDEZ	AGENT	8594053		YES	09/01/2016
PHILP JAMES DAVIS	AGENT	2636531		YES	09/01/2016
PIERCE CHARLES SMITH	AGENT	16547959		YES	09/01/2016
RANDALL L WAGERS	AGENT	11002492		YES	09/01/2016
RANDY MERRICK	AGENT	17646209		YES	09/01/2016
RICHARD ANTHONY ROBERTS	AGENT	8391190		YES	09/01/2016
STEPHEN KYLE SCHWARTZ	AGENT	17331471		YES	09/01/2016
STEVEN DEE PUGMIRE	AGENT	2628115		YES	09/01/2016
SYDNEY NESLEN	AGENT	17647372		YES	09/01/2016
TERESA MARIA PERRY	AGENT	17646170		YES	09/01/2016
THOMAS C SNYDER	AGENT	15773511		YES	09/01/2016
TRACEY JACKSON	AGENT	17403916		YES	09/01/2016
TROY ALLAN ATTANASIO	AGENT	5460727		YES	09/01/2016
TY RUSSELL	AGENT	16348360		YES	09/01/2016

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