DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Grossman, Jack Steven	DOIID	316096	NAIC NPN	290093

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	7/30/1997	7/31/2004
Inactive	Non Resident	Agent	Health	7/30/1997	7/31/2004
* 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
Inactive	Senior Health Insurance Company of Pennsylvania	300251	Agent - Health	7/30/1997	11/19/2003
Inactive	Senior Health Insurance Company of Pennsylvania	300251	Agent - Life	7/30/1997	11/19/2003

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Medlink Inc	400721	Agent - Life	8/29/2002	11/19/2003
Inactive	Medlink Inc	400721	Agent - Health	8/29/2002	11/19/2003