DEPARTMENT OF INSURANCE

Affiliations

Name	Employee Benefits Services Corporation	DOIID	399799	NAIC NPN	7221943

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Life	12/27/1993	5/31/2003
Inactive	Resident	Agent	Health Maintenance Organization	10/9/1991	3/1/2001
Inactive	Resident	Agent	Health	5/31/2001	5/31/2003
* 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	Advantage Care, Inc.	300998	Agent - Health Maintenance Organization	1/11/1994	12/1/2000
Inactive	Aetna Life Insurance Company	301140	Agent - Health	2/23/1996	5/31/2003
Inactive	Aetna Life Insurance Company	301140	Agent - Life	2/23/1996	5/31/2003
Inactive	American Bankers Life Assurance Company of Florida	300171	Agent - Health	8/6/1991	12/16/1996
Inactive	American Bankers Life Assurance Company of Florida	300171	Agent - Life	8/6/1991	12/16/1996
Inactive	American States Life Insurance Company	301884	Agent - Health	12/30/1998	11/26/2001
Inactive	American States Life Insurance Company	301884	Agent - Life	12/30/1998	11/19/2001
Inactive	Ameritas Life Insurance Corporation	300126	Agent - Health	11/1/1995	12/11/2000
Inactive	Ameritas Life Insurance Corporation	300126	Agent - Life	11/1/1995	12/11/2000
Inactive	Baptist Health Plan, Inc.	300157	Agent - Health	3/1/2001	5/31/2003
Inactive	Baptist Health Plan, Inc.	300157	Agent - Health Maintenance Organization	5/23/1994	3/1/2001
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Health	6/27/2001	5/31/2003
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Life	6/27/2001	5/31/2003
Inactive	Clarica Life Insurance Company - U.S.	300207	Agent - Health	11/21/1991	3/31/1997
Inactive	Clarica Life Insurance Company - U.S.	300207	Agent - Life	11/21/1991	3/31/1997
Inactive	Continental Casualty Company	301019	Agent - Health	7/1/1992	5/31/2003
Inactive	Guardian Life Insurance Company of America	301316	Agent - Health	4/28/1987	5/31/2003
Inactive	Guardian Life Insurance Company of America	301316	Agent - Life	4/28/1987	5/31/2003
Inactive	Hartford Life Group Insurance Company	301708	Agent - Health	3/21/2002	5/31/2003
Inactive	Hartford Life Group Insurance Company	301708	Agent - Life	3/21/2002	5/31/2003
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Health	2/13/1992	5/31/2003
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Life	2/13/1992	5/31/2003
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	3/1/2001	5/31/2003
Inactive	Humana Health Plan, Inc.	300142	Agent - Health Maintenance Organization	10/9/1991	3/1/2001
Inactive	Humana Insurance Company	301104	Agent - Health	4/4/1991	6/1/1999
Inactive	Humana Insurance Company	301104	Agent - Life	4/4/1991	6/1/1999
Inactive	Jefferson Pilot Financial Insurance Company	300756	Agent - Health	8/17/1998	5/31/2003
Inactive	Jefferson Pilot Financial Insurance Company	300756	Agent - Life	8/17/1998	5/31/2003
Inactive	Jefferson-Pilot Life Insurance Company	300379	Agent - Health	4/25/1989	3/31/1999
Inactive	Jefferson-Pilot Life Insurance Company	300379	Agent - Life	4/25/1989	3/31/1999
Inactive	John Alden Life Insurance Company	300573	Agent - Health	4/4/1988	3/31/1997
Inactive	John Alden Life Insurance Company	300573	Agent - Life	4/4/1988	3/31/1997
Inactive	Medical Life Insurance Company	300693	Agent - Health	10/26/1998	12/31/2004
Inactive	Medical Life Insurance Company	300693	Agent - Life	10/26/1998	12/31/2004
Inactive	Metropolitan Life Insurance Company	301948	Agent - Health	11/3/1997	5/31/2003
Inactive	Metropolitan Life Insurance Company	301948	Agent - Life	11/3/1997	5/31/2003
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	12/6/1996	5/31/2003
Inactive	Nippon Life Insurance Company of America	300446	Agent - Health	3/1/1994	5/31/2003
Inactive	Nippon Life Insurance Company of America	300446	Agent - Life	3/1/1994	5/31/2003
Inactive	Paul Revere Life Insurance Company	300971	Agent - Health	5/22/1992	5/31/2003
Inactive	Paul Revere Life Insurance Company	300971	Agent - Life	5/22/1992	5/31/2003
Inactive	Principal Life Insurance Company	300129	Agent - Health	3/17/1987	5/31/2003
Inactive	Principal Life Insurance Company	300129	Agent - Life	3/17/1987	5/31/2003
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	12/1/1995	5/31/2003
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	12/1/1995	5/31/2003
Inactive	Reassure America Life Insurance Company	301902	Agent - Health	8/12/1998	1/2/2003
Inactive	Reassure America Life Insurance Company	301902	Agent - Life	8/12/1998	1/2/2003
Inactive	Reliance Standard Life Insurance Company	300584	Agent - Health	6/26/1998	5/31/2003
Inactive	Reliance Standard Life Insurance Company	300584	Agent - Life	6/26/1998	5/31/2003
Inactive	Standard Insurance Company	300185	Agent - Health	10/14/1993	4/25/2003
Inactive	Standard Insurance Company	300185	Agent - Life	10/14/1993	4/25/2003
Inactive	Symetra Life Insurance Company	301691	Agent - Health	6/20/1989	5/31/2003
Inactive	Symetra Life Insurance Company	301691	Agent - Life	6/20/1989	5/31/2003
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	6/3/1988	5/31/2003
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	6/3/1988	5/31/2003
Inactive	Union Security Insurance Company	301844	Agent - Health	12/27/1993	5/31/2003
Inactive	Union Security Insurance Company	301844	Agent - Life	12/27/1993	5/31/2003
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	12/6/1996	5/31/2003
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	12/6/1996	5/31/2003
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	5/5/1999	5/31/2003
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	5/5/1999	5/31/2003
Inactive	UnitedHealthcare Life Insurance Company	301517	Agent - Health	9/30/1993	3/31/1997
Inactive	UnitedHealthcare Life Insurance Company	301517	Agent - Life	9/30/1993	3/31/1997
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	3/1/2001	5/31/2003
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health Maintenance Organization	1/21/1997	3/1/2001

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Carlson, Daryl Rolland	320146	Agent - Health	3/1/2001	5/31/2003
Inactive	Carlson, Daryl Rolland	320146	Agent - Health Maintenance Organization	6/4/1998	3/1/2001
Inactive	Humkey, John Newton	386814	Agent - Health	5/13/1994	5/31/2003
Inactive	Humkey, John Newton	386814	Agent - Life	5/13/1994	5/31/2003
Inactive	Insurance One Inc.	399840	Agent - Health	10/21/1991	12/31/2001
Inactive	Insurance One Inc.	399840	Agent - Life	10/21/1991	12/31/2001
Inactive	Luft, Ronald Lynn	359954	Agent - Health	8/15/1986	5/31/2003
Inactive	Luft, Ronald Lynn	359954	Agent - Life	8/15/1986	5/31/2003
Inactive	Ray, Kenneth Lee	338338	Agent - Health	8/15/1986	5/31/2003
Inactive	Ray, Kenneth Lee	338338	Agent - Life	8/15/1986	5/31/2003
Inactive	Ray, Leonard E	390222	Agent - Health	8/15/1986	7/1/2002
Inactive	Ray, Leonard E	390222	Agent - Life	8/15/1986	7/1/2002

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Healthplan Services, Inc.	401230	Agent - Health	8/31/1995	12/31/2001