DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Allied Benefit Systems, LLC	DOIID	665231	NAIC NPN	23442

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Administrator	Not Applicable	10/19/2007		3/31/2027
Active	Non Resident	Agent	Health	10/3/2007		3/31/2027
Inactive	Non Resident	Agent	Life	10/3/2007	4/18/2024
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Berkshire Hathaway Specialty Insurance Company	300908	Agent - Health	5/28/2024
Inactive	HCC Life Insurance Company	301827	Agent - Health	3/28/2008	12/6/2010
Inactive	HCC Life Insurance Company	301827	Agent - Life	3/28/2008	12/6/2010
Active	Nationwide Life Insurance Company	300495	Agent - Health	4/5/2024
Inactive	Nationwide Life Insurance Company	300495	Agent - Life	4/5/2024	4/18/2024
Active	QBE Insurance Corporation	300515	Agent - Health	3/30/2015
Inactive	Standard Security Life Insurance Company of NY	301487	Agent - Health	3/7/2016	12/26/2018
Active	Swiss Re Corporate Solutions America Insurance Corporation	300338	Agent - Health	5/11/2021
Inactive	Westport Insurance Corporation	301875	Agent - Health	3/7/2016	4/20/2023

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	DeClark, David Charles	1218786	Administrator - Not Applicable	8/19/2022
Inactive	Jacob, Jeri L	651945	Agent - Health	10/3/2007	4/18/2024
Inactive	Jacob, Jeri L	651945	Agent - Life	10/3/2007	4/18/2024
Denied	Mccarthy, Dan T	1328662	Agent - Health
Active	Rozmiarek, Andrew Scott	1157994	Agent - Health	4/18/2024
Inactive	Wilneff, Mitchell David	665767	Administrator - Not Applicable	10/19/2007	8/19/2022