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
KUREEN JAVON COOK	AGENT	1112887	YES		8/30/2016
MARK CULLINANE	AGENT	1117882	YES		8/30/2016
ERIK JOHN DAVIS	AGENT	1111355	YES		8/30/2016
JULIE LYN DEFOREST	AGENT	1116582	YES		8/30/2016
BUYUAN DONG	AGENT	1067880	YES		8/30/2016
ZACHARY CHRISTOPHER ENGLUND	AGENT	1110489	YES		8/30/2016
HOLLIS MAY ENRIQUEZ	AGENT	1112576	YES		8/30/2016
MAXWELL DAVID EVERINGHAM	AGENT	1116611	YES		8/30/2016
RAUL JR FIGUEROA	AGENT	1101550	YES		8/30/2016
EUGENE FRADELLOS	AGENT	1040931	YES		8/30/2016
KENNETH DALE FRATTO	AGENT	1116380	YES		8/30/2016
EUGENE FREEMAN	AGENT	1116615	YES		8/30/2016
SCOT WILLIAM GIACOMETTI	AGENT	1116623	YES		8/30/2016
BERNADETTE GONZALES	AGENT	1110639	YES		8/30/2016
BRENNAN CHRISTOPHER-SCOTT GOOD	AGENT	1116652	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