Notification of Changes for Business Entity
General Information
Business Entity Name:	EHEALTH INSURANCE
Incorporation / Formation Date:
FEIN:	77-0470789
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	CA
County:	SACRAMENTO
Business Address
Address 1:	11919 FOUNDATION PLACE, SUITE 100
Address 2:
City:	GOLD RIVER
State:	CA
Zip:	95670
Phone:	800-299-3116
Fax:
Business Web Site Address:
Business Email Address:
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:	YES

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
DUSTIN LARSEN	MAJOR LINES	18863072	YES		08/16/2018
RON HENRY MONOSSON	MAJOR LINES	13209398	YES		08/16/2018
DANIEL J MONTAGUE	MAJOR LINES	18863080	YES		08/16/2018
FRIDA VERONICA MOSES	MAJOR LINES	18864361	YES		08/16/2018
DOMINIC JOHN OLIVER	MAJOR LINES	18864353	YES		08/16/2018
MICHELLE ROCKELLE PRESNELL	MAJOR LINES	18863077	YES		08/16/2018
QUINN E PRICE	MAJOR LINES	18871774	YES		08/16/2018
TANNER DIRK PURSER	MAJOR LINES	18861378	YES		08/16/2018
SAMUEL JACOB REES	MAJOR LINES	18863078	YES		08/16/2018
RUBEN CHRISTOPHER ROBLES	MAJOR LINES	17380271	YES		08/16/2018
MATTHEW BROCK ROSE	MAJOR LINES	16909997	YES		08/16/2018
PORTER L ROSENKRANTZ	MAJOR LINES	18861348	YES		08/16/2018
MATTHEW G VAUGHAN	MAJOR LINES	17458249	YES		08/16/2018

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:	ESTY NGUYEN
Title:	LICENSING ADMINISTRATOR
Phone Number:	801-562-4051
Email Address:	LICENSING@EHEALTHINSURANCE.COM