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
JEFFREY DEAN LOTT	AGENT	1026822		YES	8/30/2016
JORDAN STUMPH-STODDARD	AGENT	988618		YES	8/30/2016
KATHERINE RUSSELL	AGENT	1073849		YES	8/30/2016
KENT LEMOYNE LEWIS	AGENT	1075710		YES	8/30/2016
KRISTI MARIE CULBERTSON	AGENT	1030465		YES	8/30/2016
LAUREL MARIE LIVEZEY	AGENT	996102		YES	8/30/2016
LAURESTON RAWSON BLAIR	AGENT	746260		YES	8/30/2016
MARCO CURTESSI	AGENT	1070631		YES	8/30/2016
MARLENA ANN DOLISON	AGENT	1070325		YES	8/30/2016
MEGHAN GETZ	AGENT	991506		YES	8/30/2016
MICHELLE CELESTE PETRUZZELLI	AGENT	1070636		YES	8/30/2016
MONICA MARY ZAJAC	AGENT	1082588		YES	8/30/2016
NATALIE BUYS	AGENT	968802		YES	8/30/2016
NATHAN AARON HESS	AGENT	1085424		YES	8/30/2016
NATHANIEL KYLE BERLANT	AGENT	1073761		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