DEPARTMENT OF INSURANCE

Affiliations

Name	Blumenthal III, Henry Simon	DOIID	394270	NAIC NPN	7210431

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Life	2/1/1993	12/1/2000
Inactive	Resident	Agent	Health	2/1/1993	12/1/2000
Inactive	Resident	Agent	Health Maintenance Organization	2/10/1993	5/6/1997
* 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	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	6/6/1994	3/31/1997
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	6/6/1994	3/31/1997
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health Maintenance Organization	2/10/1993	5/6/1997
Inactive	Chase Insurance Life and Annuity Company	300518	Agent - Health	6/6/1994	4/7/1997
Inactive	Chase Insurance Life and Annuity Company	300518	Agent - Life	6/6/1994	4/7/1997
Inactive	Citizens Security Life Insurance Company	301257	Agent - Health	5/7/1993	11/18/1996
Inactive	Citizens Security Life Insurance Company	301257	Agent - Life	5/7/1993	11/18/1996
Inactive	Forethought Life Insurance Company	301407	Agent - Health	5/7/1997	12/1/2000
Inactive	Forethought Life Insurance Company	301407	Agent - Life	5/7/1997	12/1/2000
Inactive	Golden Rule Insurance Company	301943	Agent - Health	1/19/1995	11/21/1996
Inactive	Golden Rule Insurance Company	301943	Agent - Life	1/19/1995	11/21/1996
Inactive	Guardian Life Insurance Company of America	301316	Agent - Health	2/1/1993	12/19/1996
Inactive	Guardian Life Insurance Company of America	301316	Agent - Life	2/1/1993	12/19/1996
Inactive	John Hancock Life Insurance Company	300821	Agent - Health	4/16/1996	4/21/1997
Inactive	John Hancock Life Insurance Company	300821	Agent - Life	4/16/1996	4/21/1997
Inactive	John Hancock Variable Life Insurance Company	301914	Agent - Life	2/27/1997	4/21/1997
Inactive	Metropolitan Insurance and Annuity Company	301239	Agent - Health	6/15/1994	5/4/1997
Inactive	Metropolitan Insurance and Annuity Company	301239	Agent - Life	6/15/1994	5/4/1997
Inactive	Metropolitan Life Insurance Company	301948	Agent - Health	6/15/1994	5/1/1997
Inactive	Metropolitan Life Insurance Company	301948	Agent - Life	6/15/1994	5/1/1997
Inactive	Trustmark Insurance Company	300317	Agent - Health	9/2/1993	3/31/1997
Inactive	Trustmark Insurance Company	300317	Agent - Life	9/2/1993	3/31/1997
Inactive	Zurich American Life Insurance Company	300216	Agent - Life	8/31/1994	3/31/1997

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Acordia of Louisville Inc.	401252	Agent - Life	5/26/1994	5/1/1997
Inactive	Acordia of Louisville Inc.	401252	Agent - Health	5/26/1994	5/1/1997
Inactive	Medlink Inc	400721	Agent - Life	2/11/1993	12/9/1996
Inactive	Medlink Inc	400721	Agent - Health	2/11/1993	12/9/1996