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
BARCENAS, STEWART	PRODUCER	17867970	YES		03/22/2016
BLANCHARD, NICOLE	PRODUCER	17867968	YES		03/22/2016
BUCHANAN, CLARISSA ANN	PRODUCER	17737314	YES		03/22/2016
COOPER, SINJIN WILLIAM	PRODUCER	17867965	YES		03/22/2016
DALEY, BARBARA	PRODUCER	17371449	YES		03/22/2016
DEVEY, PARKER DAVID	PRODUCER	17869306	YES		03/22/2016
EWELL, PRESTON D	PRODUCER	17869303	YES		03/22/2016
FARLEY, MATTHEW LYMAN	PRODUCER	17869226	YES		03/22/2016
GUTIERREZ, CARMINA	PRODUCER	17867964	YES		03/22/2016
HAKALA, JESSIE K	PRODUCER	17869294	YES		03/22/2016
HANAMAIKAI, QUINN T	PRODUCER	17709009	YES		03/22/2016
MONSON, CHRISTIAN N	PRODUCER	17522448	YES		03/22/2016
OLMOS, JOSEPH	PRODUCER	17871806	YES		03/22/2016
PEHRSON, MCKENZIE	PRODUCER	17866804	YES		03/22/2016
POPE, BENJAMIN PRICE	PRODUCER	17782549	YES		03/22/2016

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