Notification of Changes for Business Entity
General Information
Business Entity Name:	EHEALTH INSURANCE
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, SUITE 100
Address 2:
City:	GOLD RIVER
State:	CA
Zip:	95670
Phone:	800-299-3116
Fax:
Business Web Site Address:
Business Email Address:
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:	YES

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
THOMAS MANNIG	MAJOR LINES	18463620		YES	05/02/18
BRENDAN MARTIN	MAJOR LINES	18492159		YES	05/02/18
JANE MARTIN	MAJOR LINES	18423003		YES	05/02/18
BRENDAN M MCDAVITT	MAJOR LINES	7073859		YES	05/02/18
JASON B MEISNER	MAJOR LINES	16849304		YES	05/02/18
KALYNN MOE	MAJOR LINES	17982133		YES	05/02/18
CHRISTOPHER MURPHY	MAJOR LINES	17681898		YES	05/02/18
CHARLES NAGBE	MAJOR LINES	17674164		YES	05/02/18
KATHRYN ANNE NELSON	MAJOR LINES	17977278		YES	05/02/18
JESENIA NG	MAJOR LINES	18469688		YES	05/02/18
JULIE OURDANI	MAJOR LINES	17184921		YES	05/02/18
GEORGE RAYNE	MAJOR LINES	17622845		YES	05/02/18
JOREL RIPPON	MAJOR LINES	18488697		YES	05/02/18
ZACHARY ROME	MAJOR LINES	18060873		YES	05/02/18
SANDRA JOAN ROTH	MAJOR LINES	11781588		YES	05/02/18

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:	ESTY NGUYEN
Title:	LICENSING ASSISTANT
Phone Number:	801-562-4051
Email Address:	LICENSING@EHEALTHINSURANCE.COM