DEPARTMENT OF INSURANCE

Affiliations

Name	Black, Arthur M	DOIID	393003	NAIC NPN	1498019

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Health	9/18/2007	11/30/2011
Inactive	Non Resident	Agent	Life	9/18/2007	11/30/2011
* 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	Colonial Life and Accident Insurance Company	300846	Agent - Health	6/5/1997	4/2/1998
Inactive	Colonial Life and Accident Insurance Company	300846	Agent - Life	6/5/1997	4/2/1998
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	9/2/2009	8/31/2011
Inactive	Humana Insurance Company	301104	Agent - Health	9/2/2009	8/31/2011
Inactive	Humana Insurance Company	301104	Agent - Life	9/2/2009	8/31/2011
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	9/2/2009	8/31/2011
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	9/2/2009	8/31/2011
Inactive	HumanaDental Insurance Company	301457	Agent - Health	9/2/2009	8/31/2011
Inactive	HumanaDental Insurance Company	301457	Agent - Life	9/2/2009	8/31/2011
Inactive	Kanawha Insurance Company	300127	Agent - Health	9/2/2009	8/31/2011
Inactive	Kanawha Insurance Company	300127	Agent - Life	9/2/2009	8/31/2011
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	6/20/2008	11/30/2011
Inactive	Paul Revere Life Insurance Company	300971	Agent - Health	9/8/1999	1/31/2004
Inactive	Paul Revere Life Insurance Company	300971	Agent - Life	9/8/1999	1/31/2004
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	9/8/1999	1/31/2004
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	9/8/1999	1/31/2004
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	10/23/1998	1/31/2004
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	10/23/1998	1/31/2004
Inactive	United Concordia Life and Health Insurance Company	301220	Agent - Health	6/20/2008	11/30/2011
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	6/20/2008	11/30/2011
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	6/20/2008	11/30/2011

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Pritchard & Jerden Inc	549848	Agent - Life	10/8/2009	11/30/2011
Inactive	Pritchard & Jerden Inc	549848	Agent - Health	10/8/2009	11/30/2011