DEPARTMENT OF INSURANCE

Affiliations

Name	Gossom, Barbara D	DOIID	336263	NAIC NPN	1484455

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Health	10/10/1996	12/11/2000
Inactive	Resident	Agent	Life	10/10/1996	12/11/2000
* 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	AF&L Insurance Company	301582	Agent - Health	5/4/1998	7/26/2000
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	9/11/2000	12/11/2000
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	5/28/1997	8/22/1997
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	5/28/1997	8/22/1997
Inactive	American General Life Insurance Company of Delaware	301057	Agent - Health	10/8/1999	7/26/2000
Inactive	American General Life Insurance Company of Delaware	301057	Agent - Life	10/8/1999	7/26/2000
Inactive	Equitable Financial Life Insurance Company of America	301772	Agent - Life	11/7/1997	7/26/1999
Inactive	John Hancock Life Insurance Company	300821	Agent - Health	4/10/1997	8/22/1997
Inactive	John Hancock Life Insurance Company	300821	Agent - Life	4/10/1997	8/22/1997
Inactive	John Hancock Variable Life Insurance Company	301914	Agent - Life	5/5/1997	8/22/1997
Inactive	LifeUSA Insurance Company	300386	Agent - Life	9/11/2000	12/11/2000
Inactive	MONY Life Insurance Company	301141	Agent - Health	11/7/1997	7/26/1999
Inactive	MONY Life Insurance Company	301141	Agent - Life	11/7/1997	7/26/1999
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	7/28/1999	7/26/2000
Inactive	Nationwide Life Insurance Company	300495	Agent - Health	11/16/2000	12/11/2000
Inactive	Nationwide Life Insurance Company	300495	Agent - Life	11/16/2000	12/11/2000
Inactive	Nationwide Life and Annuity Insurance Company	300714	Agent - Life	12/5/2000	12/11/2000
Inactive	Paul Revere Life Insurance Company	300971	Agent - Health	7/8/1998	7/26/2000
Inactive	Paul Revere Life Insurance Company	300971	Agent - Life	7/8/1998	7/26/2000
Inactive	Principal Life Insurance Company	300129	Agent - Health	8/19/1998	7/26/2000
Inactive	Principal Life Insurance Company	300129	Agent - Life	8/19/1998	7/26/2000
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	7/8/1998	7/26/2000
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	7/8/1998	7/26/2000
Inactive	Pruco Life Insurance Company	300954	Agent - Health	10/10/1996	4/15/1997
Inactive	Pruco Life Insurance Company	300954	Agent - Life	10/10/1996	4/15/1997
Inactive	Prudential Insurance Company of America	300784	Agent - Health	10/10/1996	4/15/1997
Inactive	Prudential Insurance Company of America	300784	Agent - Life	10/10/1996	4/15/1997
Inactive	Southwestern Life Insurance Company	301343	Agent - Health	6/30/1999	7/26/2000
Inactive	Southwestern Life Insurance Company	301343	Agent - Life	6/30/1999	7/26/2000
Inactive	Standard Life and Accident Insurance Company	301534	Agent - Health	9/1/2000	12/11/2000
Inactive	Standard Life and Accident Insurance Company	301534	Agent - Life	9/1/2000	12/11/2000
Inactive	United American Insurance Company	300910	Agent - Health	2/1/1999	3/24/2000
Inactive	United American Insurance Company	300910	Agent - Life	2/1/1999	3/24/2000
Inactive	United Investors Life Insurance Company	301873	Agent - Health	7/26/2000	12/11/2000
Inactive	United Investors Life Insurance Company	301873	Agent - Life	7/26/2000	12/11/2000

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Cornerstone Senior Services LLC	399590	Agent - Life	6/25/1999	7/26/2000
Inactive	Cornerstone Senior Services LLC	399590	Agent - Health	6/25/1999	7/26/2000