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
MARIAH A KILCOYNE	MAJOR LINES	18718926	YES		04/12/2018
BRIANA MICHELLE LADWIG	MAJOR LINES	18718916	YES		04/12/2018
PATRICIA ANN LEBLANC	MAJOR LINES	18517161	YES		04/12/2018
IRMA P LERMA	MAJOR LINES	18018315	YES		04/12/2018
PATRICIA LAURINDA LEWIS	MAJOR LINES	17392155	YES		04/12/2018
THOMAS J MACWILLIAMS	MAJOR LINES	18410929	YES		04/12/2018
WILLIAM S MCGINN II	MAJOR LINES	18146758	YES		04/12/2018
PATRICK M MCWHORTER	MAJOR LINES	17087809	YES		04/12/2018
CASSIDY P MICHAEL	MAJOR LINES	18477380	YES		04/12/2018
CHRISTA GAIL OLLER	MAJOR LINES	17542223	YES		04/12/2018
MEREDITH S PARK	MAJOR LINES	18415564	YES		04/12/2018
MARK R PRZYBYLA	MAJOR LINES	18688569	YES		04/12/2018
TERESA MADELINE RANK	MAJOR LINES	16967929	YES		04/12/2018
SCOTT C RAULIE	MAJOR LINES	18069881	YES		04/12/2018
DIANA LESLIE ROE	MAJOR LINES	14747337	YES		04/12/2018

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