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:	916-608-6183
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
ALFREDO A VALLEJOS	MAJOR LINES	18421368	YES		03/13/2018
BRENDAN MARTIN	MAJOR LINES	18492159	YES		03/13/2018
CHRISTINA LAFERRIERE	MAJOR LINES	18492105	YES		03/13/2018
CHRISTOPHER CODY HEMSLEY	MAJOR LINES	18420222	YES		03/13/2018
JESENIA NG	MAJOR LINES	18469688	YES		03/13/2018
JESSE C OCHS	MAJOR LINES	18495447	YES		03/13/2018
JOHN NIELSON	MAJOR LINES	18497418	YES		03/13/2018
JOREL RIPPON	MAJOR LINES	18488697	YES		03/13/2018
MICHAEL TAYLOR RUSSO	MAJOR LINES	18436127	YES		03/13/2018
THOMAS A MANNING	MAJOR LINES	18463620	YES		03/13/2018

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