DEPARTMENT OF INSURANCE

Affiliations

Name	Tri-State Brokerage Inc.	DOIID	399941	NAIC NPN	1682543

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Life	9/8/1993	3/31/2021
Inactive	Non Resident	Agent	Health	9/8/1993	3/31/2021
* 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	Aetna Health Inc. (PA)	660717	Agent - Health	5/22/2008	9/22/2010
Inactive	Aetna Life Insurance Company	301140	Agent - Health	5/22/2008	9/22/2010
Inactive	Aetna Life Insurance Company	301140	Agent - Life	5/22/2008	9/22/2010
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Health	7/5/2000	5/20/2005
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	7/5/2000	5/20/2005
Inactive	American Fidelity Assurance Company	301004	Agent - Health	3/23/2007	4/6/2007
Inactive	American Fidelity Assurance Company	301004	Agent - Life	3/23/2007	4/6/2007
Inactive	American General Life Insurance Company	301585	Agent - Health	9/3/2002	1/17/2018
Inactive	American General Life Insurance Company	301585	Agent - Life	9/3/2002	1/17/2018
Inactive	American National Insurance Company	301861	Agent - Health	2/5/2010	3/31/2021
Inactive	American National Insurance Company	301861	Agent - Life	3/11/2004	3/31/2021
Inactive	Assurity Life Insurance Company	301099	Agent - Health	11/15/2004	4/8/2005
Inactive	Assurity Life Insurance Company	301099	Agent - Life	11/15/2004	4/8/2005
Inactive	Athene Annuity & Life Assurance Company	301798	Agent - Health	5/22/2006	6/7/2011
Inactive	Athene Annuity & Life Assurance Company	301798	Agent - Life	5/22/2006	6/7/2011
Inactive	Brighthouse Life Insurance Company	301829	Agent - Health	11/14/2014	3/31/2021
Inactive	Brighthouse Life Insurance Company	301829	Agent - Life	11/14/2014	3/31/2021
Inactive	Central States Health and Life Company of Omaha	301874	Agent - Health	9/25/2002	12/29/2004
Inactive	Central States Health and Life Company of Omaha	301874	Agent - Life	9/25/2002	12/29/2004
Inactive	Chesapeake Life Insurance Company (The)	301017	Agent - Health	7/12/2004	3/31/2006
Inactive	Chesapeake Life Insurance Company (The)	301017	Agent - Life	7/12/2004	3/31/2006
Inactive	Citizens Security Life Insurance Company	301257	Agent - Health	8/24/2006	3/31/2021
Inactive	Citizens Security Life Insurance Company	301257	Agent - Life	8/24/2006	3/31/2021
Inactive	Clarendon National Insurance Company	300843	Agent - Health	10/4/2002	4/20/2005
Inactive	Colorado Bankers Life Insurance Company	301845	Agent - Health	4/22/2008	7/18/2019
Inactive	Colorado Bankers Life Insurance Company	301845	Agent - Life	4/22/2008	7/18/2019
Inactive	Companion Life Insurance Company	300191	Agent - Health	10/15/1998	12/16/2004
Inactive	Companion Life Insurance Company	300191	Agent - Life	10/15/1998	12/16/2004
Denied	Conseco Health Insurance Company	301725	Agent - Health
Denied	Conseco Health Insurance Company	301725	Agent - Life
Inactive	Conseco Insurance Company	301202	Agent - Health	8/9/2004	10/6/2009
Inactive	Conseco Insurance Company	301202	Agent - Life	8/9/2004	10/6/2009
Inactive	Conseco Medical Insurance Company	300719	Agent - Health	4/22/1997	11/21/2001
Inactive	Conseco Medical Insurance Company	300719	Agent - Life	4/22/1997	11/21/2001
Inactive	Continental General Insurance Company	300691	Agent - Health	7/2/1997	4/6/1998
Inactive	Continental General Insurance Company	300691	Agent - Life	7/2/1997	4/6/1998
Inactive	Fidelity Life Association, A Legal Reserve Life Insurance Company	300774	Agent - Life	5/25/2006	4/5/2012
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Health	11/10/2003	11/8/2006
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Life	11/10/2003	11/8/2006
Inactive	Genworth Life Insurance Company	300623	Agent - Health	8/1/2009	12/7/2012
Inactive	Genworth Life Insurance Company	300623	Agent - Life	8/1/2009	12/7/2012
Inactive	Gerber Life Insurance Company	300529	Agent - Health	3/30/2010	12/26/2012
Inactive	Gerber Life Insurance Company	300529	Agent - Life	3/30/2010	12/26/2012
Inactive	Guarantee Trust Life Insurance Company	301043	Agent - Health	11/1/2004	1/27/2009
Inactive	Guarantee Trust Life Insurance Company	301043	Agent - Life	11/1/2004	1/27/2009
Inactive	Investors Life Insurance Company of North America	301660	Agent - Life	3/27/2006	8/13/2008
Inactive	Jefferson National Life Insurance Company	300258	Agent - Life	11/17/2004	6/8/2006
Inactive	John Hancock Life Insurance Company	300821	Agent - Health	8/12/2009	12/30/2009
Inactive	John Hancock Life Insurance Company	300821	Agent - Life	8/12/2009	12/30/2009
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Health	12/30/2009	3/31/2021
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Life	12/30/2009	3/31/2021
Inactive	Kansas City Life Insurance Company	301444	Agent - Health	3/31/1997	4/25/2005
Inactive	Kansas City Life Insurance Company	301444	Agent - Life	3/31/1997	4/25/2005
Inactive	Liberty Life Insurance Company	301542	Agent - Health	8/6/2004	6/30/2006
Inactive	Liberty Life Insurance Company	301542	Agent - Life	8/6/2004	6/30/2006
Inactive	LifeSecure Insurance Company	301629	Agent - Health	7/25/1997	12/17/1997
Inactive	LifeSecure Insurance Company	301629	Agent - Life	7/25/1997	12/17/1997
Inactive	Loyal American Life Insurance Company	301172	Agent - Health	10/12/2018	12/21/2018
Inactive	Loyal American Life Insurance Company	301172	Agent - Life	10/12/2018	12/21/2018
Inactive	MedAmerica Insurance Company	301568	Agent - Health	7/29/2009	1/5/2011
Inactive	MetLife Investors USA Insurance Company	300845	Agent - Health	6/1/2009	11/14/2014
Inactive	MetLife Investors USA Insurance Company	300845	Agent - Life	6/1/2009	11/14/2014
Inactive	Metropolitan Life Insurance Company	301948	Agent - Health	2/26/2014	12/13/2018
Inactive	Metropolitan Life Insurance Company	301948	Agent - Life	2/26/2014	12/13/2018
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	7/29/2004	8/15/2012
Inactive	Nassau Life Insurance Company of Kansas	300667	Agent - Health	3/30/2005	2/20/2015
Inactive	Nassau Life Insurance Company of Kansas	300667	Agent - Life	3/30/2005	2/20/2015
Inactive	Old Line Life Insurance Company of America (The)	301709	Agent - Health	10/23/2001	3/31/2003
Inactive	Old Line Life Insurance Company of America (The)	301709	Agent - Life	10/23/2001	3/31/2003
Inactive	Pan-American Assurance Company	301533	Agent - Health	7/9/2003	3/6/2007
Inactive	Pan-American Assurance Company	301533	Agent - Life	7/9/2003	3/6/2007
Inactive	Pan-American Life Insurance Company	301530	Agent - Health	7/9/2003	3/6/2007
Inactive	Pan-American Life Insurance Company	301530	Agent - Life	7/9/2003	3/6/2007
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	3/17/2005	12/30/2009
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	3/17/2005	12/30/2009
Inactive	ReliaStar Life Insurance Company	301712	Agent - Health	3/2/2006	8/18/2007
Inactive	ReliaStar Life Insurance Company	301712	Agent - Life	4/1/2009	10/6/2012
Inactive	Security Life of Denver Insurance Company	300648	Agent - Life	4/1/2009	9/29/2012
Inactive	Senior Health Insurance Company of Pennsylvania	300251	Agent - Health	5/31/2001	11/19/2003
Inactive	Senior Health Insurance Company of Pennsylvania	300251	Agent - Life	5/31/2001	11/19/2003
Inactive	Standard Life and Accident Insurance Company	301534	Agent - Health	4/12/2010	8/25/2014
Inactive	Standard Life and Accident Insurance Company	301534	Agent - Life	4/12/2010	8/25/2014
Inactive	Standard Security Life Insurance Company of NY	301487	Agent - Health	4/1/2010	12/27/2018
Inactive	Standard Security Life Insurance Company of NY	301487	Agent - Life	4/1/2010	12/27/2018
Inactive	Transamerica Life Insurance Company	300571	Agent - Health	4/15/2010	3/31/2021
Inactive	Transamerica Life Insurance Company	300571	Agent - Life	4/15/2010	3/31/2021
Inactive	Transamerica Life Insurance and Annuity Company	300148	Agent - Life	3/11/2004	10/1/2005
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	3/17/2005	12/30/2009
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	3/17/2005	12/30/2009
Inactive	Union Bankers Insurance Company	301769	Agent - Health	12/4/1996	6/12/1998
Inactive	Union Bankers Insurance Company	301769	Agent - Life	12/4/1996	6/12/1998
Inactive	United States Life Insurance Company in the City of New York	301126	Agent - Health	8/5/1999	3/31/2021
Inactive	United States Life Insurance Company in the City of New York	301126	Agent - Life	8/5/1999	3/31/2021
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	7/29/2004	8/15/2012
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	7/29/2004	8/15/2012
Inactive	Washington National Insurance Company	300587	Agent - Health	9/8/1993	6/21/1999
Inactive	Washington National Insurance Company	300587	Agent - Life	9/8/1993	6/21/1999
Inactive	West Coast Life Insurance Company	301607	Agent - Life	12/28/2004	12/13/2011
Inactive	Western National Life Insurance Company	300461	Agent - Life	11/16/2001	11/12/2003
Inactive	Western Reserve Life Assurance Company of Ohio	300760	Agent - Life	7/20/2009	10/28/2010
Inactive	Wilco Life Insurance Company	300122	Agent - Life	10/12/1998	5/19/2009

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Daugherty, Pat M	373060	Agent - Health	1/14/2005	4/14/2014
Inactive	Daugherty, Pat M	373060	Agent - Life	1/14/2005	4/14/2014
Inactive	Kanatzar, Joe E	507161	Agent - Health	1/14/2005	11/30/2020
Inactive	Kanatzar, Joe E	507161	Agent - Life	1/14/2005	11/30/2020
Inactive	Kanatzar, Joe Ed	345934	Agent - Health	9/3/1993	3/31/2021
Inactive	Kanatzar, Joe Ed	345934	Agent - Life	9/3/1993	3/31/2021