Notification of Changes for Business Entity
General Information  
Business Entity Name: EHEALTH INSURANCE SERVICES, INC.
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 STE. #100
Address 2:  
City: GOLD RIVER
State: CA
Zip: 95670
Phone: 916-608-6183
Fax:  
Business Web Site Address:  
Business Email Address: LICENSING@EHEALTHINSURANCE.COM
Mailing Address  
Address 1: 11919 FOUNDATION PLACE STE. #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
NATHAN J. FINE AGENT 18083751   YES 02/14/2017
MARK W. WATKINS AGENT 2706164   YES 02/14/2017
JEFFREY M. MYERS AGENT 9580241   YES 02/14/2017
RICHARD A. ROBERTS AGENT 8391190   YES 02/14/2017
PATRICIANNE L. TINGLE-KEY AGENT 17528052   YES 02/14/2017
KENNETH E. BROWN AGENT 17127669   YES 02/14/2017
DANIELA A. CHAVEZ AGENT 3983292   YES 02/14/2017
TOMMY J. DEHOFF AGENT 7888207   YES 02/14/2017
           
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: BRITTANY JACKSON
Title: LICENSING ASSISTANT
Phone Number: 916-608-6153
Email Address: LICENSING@EHEALTHINSURANCE.COM