DEPARTMENT OF INSURANCE

Affiliations

Name	Premium Health Services Inc.	DOIID	399517	NAIC NPN	7221719

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Life	8/31/1994	3/31/2014
Inactive	Resident	Agent	Health	8/31/1994	3/31/2014
* 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	4/24/2007
Inactive	Conseco Health Insurance Company	301725	Agent - Life	9/6/2000	4/24/2007
Inactive	Conseco Insurance Company	301202	Agent - Health	11/30/2004	10/1/2010
Inactive	Conseco Insurance Company	301202	Agent - Life	11/30/2004	10/1/2010
Inactive	Forethought Life Insurance Company	301407	Agent - Health	3/2/2011	2/21/2014
Inactive	Forethought Life Insurance Company	301407	Agent - Life	3/2/2011	2/21/2014
Inactive	Gerber Life Insurance Company	300529	Agent - Health	7/1/2010	12/26/2012
Inactive	Gerber Life Insurance Company	300529	Agent - Life	7/1/2010	12/26/2012
Inactive	Lincoln Heritage Life Insurance Company	500016	Agent - Health	1/18/2005	4/21/2010
Inactive	Lincoln Heritage Life Insurance Company	500016	Agent - Life	1/18/2005	4/21/2010
Inactive	Loyal American Life Insurance Company	301172	Agent - Health	11/19/2007	12/7/2010
Inactive	Loyal American Life Insurance Company	301172	Agent - Life	11/19/2007	12/7/2010
Inactive	Midland National Life Insurance Company	300923	Agent - Life	10/25/2010	12/20/2012
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	7/8/2010	12/26/2012
Inactive	Pioneer Life Insurance Company	300110	Agent - Health	8/31/1994	8/20/2003
Inactive	Pioneer Life Insurance Company	300110	Agent - Life	8/31/1994	8/20/2003
Inactive	Provident American Life & Health Insurance Company	300413	Agent - Health	8/4/2007	11/28/2008
Inactive	Provident American Life & Health Insurance Company	300413	Agent - Life	8/4/2007	11/28/2008
Inactive	Senior Health Insurance Company of Pennsylvania	300251	Agent - Health	12/6/2000	11/19/2003
Inactive	Senior Health Insurance Company of Pennsylvania	300251	Agent - Life	12/6/2000	11/19/2003
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	7/8/2010	12/26/2012
Inactive	Washington National Insurance Company	300587	Agent - Health	10/1/2010	12/5/2011
Inactive	Washington National Insurance Company	300587	Agent - Life	10/1/2010	12/5/2011

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Foti, John Frank	329777	Agent - Health	2/22/1988	3/31/2014
Inactive	Foti, John Frank	329777	Agent - Life	2/22/1988	3/31/2014