Notification of Changes for Business Entity
General Information
Business Entity Name:	EHEALTHINSURANCE SERVICES, INC.
Incorporation / Formation Date:
FEIN:	77-0470789
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	CA
County:	GOLD RIVER
Business Address
Address 1:	11919 FOUNDATION PLACE STE. 100
Address 2:
City:	GOLD RIVER
State:	CA
Zip:	95670
Phone:	8015624012
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
TRENTON ARRINGTON	PRODUCER	5459113	YES		05/12/2016
NATHAN BECKSTRAND	PRODUCER	17923871	YES		05/12/2016
SCOTT BENNION	PRODUCER	17925267	YES		05/12/2016
GALE COSKEY	PRODUCER	15829375	YES		05/12/2016
KELTON COTTERMAN	PRODUCER	17923879	YES		05/12/2016
JOEL HARDISTY	PRODUCER	17920946	YES		05/12/2016
AUDREY HILLER	PRODUCER	5448451	YES		05/12/2016
DAVID MORGAN	PRODUCER	17331538	YES		05/12/2016
TYLER MORGAN	PRODUCER	17851152	YES		05/12/2016
MICHAEL MORTENSEN	PRODUCER	17920937	YES		05/12/2016
NANCY MOTA	PRODUCER	17920544	YES		05/12/2016
SALVADOR PEREZ	PRODUCER	17920933	YES		05/12/2016
STEPHANIE PHAM	PRODUCER	17918311	YES		05/12/2016
STEPHEN PITTS	PRODUCER	17923872	YES		05/12/2016
MICHAEL REYNOLDS	PRODUCER	17331472	YES		05/12/2016

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:	SCOTT ROSANDER
Title:	LICENSING DEPARTMENT
Phone Number:	8015624012
Email Address:	LICENSING@EHEALTHINSURANCE.COM