DEPARTMENT OF INSURANCE

Affiliations

Name	Midstates Brokerage Inc.	DOIID	400087	NAIC NPN	2110461

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Life	5/31/2001	3/31/2008
Inactive	Resident	Agent	Health	4/21/1988	3/31/2008
Inactive	Resident	Agent	Health Maintenance Organization	1/14/1999	3/1/2001
* 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 Life Insurance Company	301140	Agent - Health	4/20/2000	3/31/2008
Inactive	Aetna Life Insurance Company	301140	Agent - Life	5/31/2001	3/31/2008
Inactive	American Fidelity Assurance Company	301004	Agent - Health	1/24/2000	12/22/2004
Inactive	American Fidelity Assurance Company	301004	Agent - Life	5/31/2001	12/22/2004
Inactive	American Heritage Life Insurance Company	300272	Agent - Health	1/13/1989	3/31/2008
Inactive	American Heritage Life Insurance Company	300272	Agent - Life	5/31/2001	3/31/2008
Inactive	American National Insurance Company	301861	Agent - Health	9/8/1995	3/31/2008
Inactive	American National Insurance Company	301861	Agent - Life	5/31/2001	3/31/2008
Inactive	Ameritas Life Insurance Corporation	300126	Agent - Health	6/19/2002	10/23/2006
Inactive	Ameritas Life Insurance Corporation	300126	Agent - Life	6/19/2002	10/23/2006
Inactive	Anthem Life Insurance Company	301209	Agent - Health	3/16/2000	3/31/2008
Inactive	Anthem Life Insurance Company	301209	Agent - Life	5/31/2001	3/31/2008
Inactive	Baptist Health Plan, Inc.	300157	Agent - Health	3/1/2001	3/31/2008
Inactive	Baptist Health Plan, Inc.	300157	Agent - Health Maintenance Organization	4/19/1999	3/1/2001
Inactive	Brighthouse Life Insurance Company	301829	Agent - Health	5/21/1992	4/15/2005
Inactive	Brighthouse Life Insurance Company	301829	Agent - Life	5/31/2001	4/15/2005
Inactive	CIGNA Dental Health of Kentucky, Inc.	300904	Agent - Health	10/22/2001	1/9/2006
Inactive	Centennial Life Insurance Company (The)	301561	Agent - Health	3/12/1996	3/31/1997
Inactive	Centennial Life Insurance Company (The)	301561	Agent - Life	3/12/1996	3/31/1997
Inactive	Citizens Security Life Insurance Company	301257	Agent - Health	8/16/1989	3/31/2008
Inactive	Citizens Security Life Insurance Company	301257	Agent - Life	5/31/2001	3/31/2008
Inactive	Clarendon National Insurance Company	300843	Agent - Health	2/5/2001	3/31/2008
Inactive	Companion Life Insurance Company	300191	Agent - Health	10/19/2001	1/19/2005
Inactive	Companion Life Insurance Company	300191	Agent - Life	10/19/2001	1/19/2005
Inactive	Connecticut General Life Insurance Company	301333	Agent - Health	10/22/2001	1/9/2006
Inactive	Connecticut General Life Insurance Company	301333	Agent - Life	10/22/2001	1/9/2006
Inactive	Conseco Medical Insurance Company	300719	Agent - Health	12/23/1996	12/23/1998
Inactive	Conseco Medical Insurance Company	300719	Agent - Life	12/23/1996	12/23/1998
Inactive	Continental General Insurance Company	300691	Agent - Health	12/5/1988	4/2/1999
Inactive	Continental General Insurance Company	300691	Agent - Life	12/5/1988	4/2/1999
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	6/17/2002	3/31/2008
Inactive	FMH Ag Risk Insurance Company	300425	Agent - Health	3/7/1994	3/31/2002
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Health	12/4/2000	3/31/2008
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Life	5/31/2001	3/31/2008
Inactive	First Colony Life Insurance Company	301179	Agent - Life	7/12/1999	7/19/2004
Inactive	General American Life Insurance Company	300280	Agent - Life	5/31/2001	12/28/2006
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	3/21/2007	3/31/2008
Inactive	Humana Insurance Company	301104	Agent - Health	5/29/2001	3/31/2008
Inactive	Humana Insurance Company	301104	Agent - Life	5/31/2001	3/31/2008
Inactive	HumanaDental Insurance Company	301457	Agent - Health	10/18/2001	3/31/2008
Inactive	Metropolitan Life Insurance Company	301948	Agent - Health	4/7/1995	3/31/2008
Inactive	Metropolitan Life Insurance Company	301948	Agent - Life	5/31/2001	3/31/2008
Inactive	Nationwide Life Insurance Company	300495	Agent - Health	8/31/1988	9/1/1998
Inactive	Nationwide Life Insurance Company	300495	Agent - Life	8/31/1988	9/1/1998
Inactive	Optum Insurance of Ohio, Inc	301226	Agent - Health	10/21/1992	3/31/1997
Inactive	Optum Insurance of Ohio, Inc	301226	Agent - Life	10/21/1992	3/31/1997
Inactive	Pan-American Life Insurance Company	301530	Agent - Health	8/26/1994	12/31/1998
Inactive	Pan-American Life Insurance Company	301530	Agent - Life	8/26/1994	12/31/1998
Inactive	Paul Revere Life Insurance Company	300971	Agent - Health	10/23/1999	12/11/2002
Inactive	Paul Revere Life Insurance Company	300971	Agent - Life	10/23/1999	12/11/2002
Inactive	Penn Mutual Life Insurance Company	301394	Agent - Health	9/21/1994	3/31/1997
Inactive	Penn Mutual Life Insurance Company	301394	Agent - Life	9/21/1994	3/31/1997
Inactive	Principal Life Insurance Company	300129	Agent - Health	2/24/1999	3/31/2008
Inactive	Principal Life Insurance Company	300129	Agent - Life	5/31/2001	3/31/2008
Inactive	Protective Life Insurance Company	300638	Agent - Health	1/16/1996	3/31/2008
Inactive	Protective Life Insurance Company	300638	Agent - Life	5/31/2001	3/31/2008
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	9/29/1999	11/10/2004
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	5/31/2001	11/10/2004
Inactive	Prudential Insurance Company of America	300784	Agent - Health	2/12/1999	3/31/2008
Inactive	Prudential Insurance Company of America	300784	Agent - Life	5/31/2001	3/31/2008
Inactive	Security Financial Life Insurance Company	300208	Agent - Health	6/19/2002	4/21/2004
Inactive	Security Financial Life Insurance Company	300208	Agent - Life	6/19/2002	4/21/2004
Inactive	Security Life Insurance Company of America	300936	Agent - Health	7/11/1996	3/31/1997
Inactive	Security Life Insurance Company of America	300936	Agent - Life	7/11/1996	3/31/1997
Inactive	Security Life of Denver Insurance Company	300648	Agent - Life	10/1/2004	2/14/2005
Inactive	Shenandoah Life Insurance Company	300130	Agent - Health	4/21/1988	12/19/2001
Inactive	Shenandoah Life Insurance Company	300130	Agent - Life	4/21/1988	12/19/2001
Inactive	Southland Life Insurance Company	301175	Agent - Life	5/31/2001	10/1/2004
Inactive	Standard Life and Accident Insurance Company	301534	Agent - Health	12/20/2001	3/31/2008
Inactive	Standard Life and Accident Insurance Company	301534	Agent - Life	12/20/2001	3/31/2008
Inactive	Standard Security Life Insurance Company of NY	301487	Agent - Health	6/12/1991	8/2/1999
Inactive	Standard Security Life Insurance Company of NY	301487	Agent - Life	6/12/1991	8/2/1999
Inactive	Sun Life Assurance Company of Canada	301811	Agent - Health	3/22/1995	6/7/1999
Inactive	Sun Life Assurance Company of Canada	301811	Agent - Life	3/22/1995	6/7/1999
Inactive	Symetra Life Insurance Company	301691	Agent - Health	8/14/2000	3/31/2008
Inactive	Symetra Life Insurance Company	301691	Agent - Life	5/31/2001	3/31/2008
Inactive	Time Insurance Company	300683	Agent - Health	3/29/2001	11/21/2002
Inactive	Time Insurance Company	300683	Agent - Life	3/30/2001	11/21/2002
Inactive	Trustmark Insurance Company	300317	Agent - Health	4/3/1990	3/31/2008
Inactive	Trustmark Insurance Company	300317	Agent - Life	5/31/2001	3/31/2008
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	10/20/1989	11/10/2004
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	5/31/2001	11/10/2004
Inactive	Union Central Life Insurance Company	300307	Agent - Health	8/31/2000	8/11/2006
Inactive	Union Central Life Insurance Company	300307	Agent - Life	5/31/2001	8/11/2006
Inactive	Union Labor Life Insurance Company	301832	Agent - Health	12/30/1998	3/31/2008
Inactive	Union Labor Life Insurance Company	301832	Agent - Life	5/31/2001	3/31/2008
Inactive	United States Life Insurance Company in the City of New York	301126	Agent - Health	11/2/2004	3/31/2008
Inactive	United States Life Insurance Company in the City of New York	301126	Agent - Life	11/2/2004	3/31/2008
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	4/24/1995	9/22/2003
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	4/24/1995	9/22/2003
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	3/1/2001	5/24/2005
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health Maintenance Organization	1/14/1999	3/1/2001
Inactive	Washington National Insurance Company	300587	Agent - Health	4/12/1995	3/31/1997
Inactive	Washington National Insurance Company	300587	Agent - Life	4/12/1995	3/31/1997

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Arison Insurance Services, Inc.	401001	Agent - Health	10/28/1999	12/31/2001
Inactive	Arison Insurance Services, Inc.	401001	Agent - Life	10/28/1999	12/31/2001
Inactive	Bowling, George R	365176	Agent - Health	7/21/1986	3/31/2008
Inactive	Bowling, George R	365176	Agent - Life	7/21/1986	3/31/2008
Inactive	Campbell, John Louis	351599	Agent - Health	7/21/1986	3/31/2008
Inactive	Campbell, John Louis	351599	Agent - Life	7/21/1986	3/31/2008