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: SACRAMENTO
Business Address  
Address 1: 11919 FOUNDATION PLACE, STE 100
Address 2:  
City: GOLD RIVER
State: CA
Zip: 95670
Phone: 8002993116
Fax:  
Business Web Site Address:  
Business Email Address:  
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
BRETT SCOTT AKIYAMA MAJOR LINES 18495454   YES 10/11/2017
KAREN MCKINNEY MAJOR LINES 17623630   YES 10/11/2017
ALAN ABBER MAJOR LINES 8466403   YES 10/11/2017
ROBERT P. MCLARNEY MAJOR LINES 17295065   YES 10/11/2017
MCKAYLA SMITH MAJOR LINES 18487574   YES 10/11/2017
           
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)
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: EMILY BAILEY
Title: LICENSING ASSISTANT
Phone Number: 801-562-4024
Email Address: LICENSING@EHEALTHINSURANCE.COM