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 PL #100
Address 2:
City:	GOLD RIVER
State:	CA
Zip:	95670
Phone:	9166086183
Fax:
Business Web Site Address:
Business Email Address:	LICENSING@EHEALTHINSURANCE.COM
Mailing Address
Address 1:	11919 FOUNDATION PL #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
ALMA LOUISE BENNETT	AGENT	17063621		YES	09/01/2016
ANASENI TAKIPO CHANDLER	AGENT	15987090		YES	09/01/2016
ANDRES EDWARD HORN	AGENT	17027439		YES	09/01/2016
ANGELA KATHLEEN ROCHA	AGENT	7740504		YES	09/01/2016
ANH LY	AGENT	16914246		YES	09/01/2016
ANTHONY JAMES GARAY	AGENT	16699600		YES	09/01/2016
ASHLEY BENNETT	AGENT	17745101		YES	09/01/2016
BARBARA CATHERINE LECERC	AGENT	8164171		YES	09/01/2016
BARBARA JEAN BASILE	AGENT	17185947		YES	09/01/2016
BARRETT GORDON-CARROLL	AGENT	17665341		YES	09/01/2016
BENJAMIN SIGMUND BARTH	AGENT	10951148		YES	09/01/2016
BRADLEY MICHAEL BAHAN	AGENT	16840398		YES	09/01/2016
BRENT THOMPSON	AGENT	16727887		YES	09/01/2016
BREON H HOWE	AGENT	17123710		YES	09/01/2016
CAMERON LEE BACKHAM	AGENT	10740778		YES	09/01/2016

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)	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:	BARBARA CROSS
Title:	LICENSING ASSISTANT
Phone Number:	916-608-6183
Email Address:	LICENSING@EHEALTHINSURANCE.COM