Notification of Changes for Business Entity
General Information
Business Entity Name:	EHEALTHINSURANCE SERVICES, INC
Incorporation / Formation Date:
FEIN:	77-0470789
Ohio License Number:	25097
NPN:	2971515
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 6165
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
AHMED, MOWLID M	PRODUCER	18497351	YES		8/22/17
ALNER, E JOHN III	PRODUCER	5410084	YES		8/22/17
ANDREU QUILES, RICARDO	PRODUCER	18487563	YES		8/22/17
BICCHIERI, CASSANDRA	PRODUCER	18483434	YES		8/22/17
BYRNE, KAREN	PRODUCER	18487556	YES		8/22/17
CASTAGNO, RYAN	PRODUCER	17694265	YES		8/22/17
CROOKSTON, JULIA	PRODUCER	18495444	YES		8/22/17
FEVRIER, STANLEY	PRODUCER	13619516	YES		8/22/17
FORNOS, RAUL	PRODUCER	18487577	YES		8/22/17
GRAY, JAMI	PRODUCER	18448323	YES		8/22/17
GUYTON, RICHARD	PRODUCER	18497344	YES		8/22/17
HIGH, TIMOTHY	PRODUCER	18487558	YES		8/22/17
HOFFMAN, LISA ANN	PRODUCER	9288579	YES		8/22/17
JUDD, MARK A	PRODUCER	2879014	YES		8/22/17
KING, JEAN ELLEN	PRODUCER	18492162	YES		8/22/17

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)	NO
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?	NO
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:	KATHY LONG-TURNER
Title:	LICENSING ASSISTANT
Phone Number:	916 608 6165
Email Address:	916 608 4141