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 PLACE
Address 2:	SUITE 100
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
Address 2:	SUITE 100
City:	GOLD RIVER
State:	OH
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
KUREEN COOK	AGENT / PRODUCER	18022295		YES	03/15/2018
LOLA HERRERA	AGENT / PRODUCER	8724126		YES	03/15/2018
MARIE BOYS	AGENT / PRODUCER	18416468		YES	03/15/2018
MEGAN MILLIKEN	AGENT / PRODUCER	18150641		YES	03/15/2018
RANDAL WHITTEN	AGENT / PRODUCER	18073066		YES	03/15/2018
RICHARD CARUSO	AGENT / PRODUCER	8290459		YES	03/15/2018
RODERICK "SCOTT" SANCHEZ	AGENT / PRODUCER	8140121		YES	03/15/2018
RONALD GIBSON	AGENT / PRODUCER	17392865		YES	03/15/2018
SAVOY MEDEIROS	AGENT / PRODUCER	17120886		YES	03/15/2018
SHELLEY URAM	AGENT / PRODUCER	18505398		YES	03/15/2018
SHERILYN OWEN-MANIOTES	AGENT / PRODUCER	17572011		YES	03/15/2018
TOMMY DEHOFF	AGENT / PRODUCER	7888207		YES	03/15/2018
TYLER WILLIAMS	AGENT / PRODUCER	8301959		YES	03/15/2018
ZACHARY ENGLUND	AGENT / PRODUCER	17986301		YES	03/15/2018

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)	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:	BRITTANY JACKSON
Title:	LICENSING ASSISTANT
Phone Number:	916-608-6183
Email Address:	BRITTANY.JACKSON2@EHEALTHINSURANCE.COM