DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Southern Insurance Group of America Inc.	DOIID	399003	NAIC NPN	3007860

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	6/12/1996	5/31/2004
Inactive	Non Resident	Agent	Life	6/12/1996	5/31/2004
* 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	Conseco Health Insurance Company	301725	Agent - Health	9/6/2000	5/31/2004
Inactive	Conseco Health Insurance Company	301725	Agent - Life	9/6/2000	5/31/2004
Inactive	Pioneer Life Insurance Company	300110	Agent - Health	6/12/1996	7/1/2003
Inactive	Pioneer Life Insurance Company	300110	Agent - Life	6/12/1996	7/1/2003
Inactive	Washington National Insurance Company	300587	Agent - Health	7/1/2003	5/31/2004
Inactive	Washington National Insurance Company	300587	Agent - Life	7/1/2003	5/31/2004

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Gilliam, Emily Ann	341034	Agent - Health	6/12/1996	8/18/2003
Inactive	Gilliam, Emily Ann	341034	Agent - Life	6/12/1996	8/18/2003
Inactive	Gilliam, Mark Quinn	348603	Agent - Health	6/12/1996	5/31/2004
Inactive	Gilliam, Mark Quinn	348603	Agent - Life	6/12/1996	5/31/2004