DEPARTMENT OF INSURANCE
Affiliations
NameEmployee Benefits Administrators, Inc.DOIID401273NAIC NPN7223003
License - Line of Authority Information
StatusResidencyClassLine of AuthorityActive DateInactive DateLicense Expiration Date
InactiveResidentAdministratorNot Applicable2/11/19933/31/2014 
InactiveResidentAgentHealth6/25/19923/31/2014 
InactiveResidentAgentLife6/25/19923/31/2014 
InactiveResidentAgentGeneral Lines2/3/20008/15/2000 
InactiveResidentAgentProperty8/15/20003/31/2014 
InactiveResidentAgentPrepaid Dental Plan12/9/19983/1/2001 
InactiveResidentAgentHealth Maintenance Organization8/12/19983/1/2001 
InactiveResidentAgentCasualty8/15/20003/31/2014 
* 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
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveACE American Insurance Company300625Agent - Health6/11/20032/26/2007
DeniedAllianz Life Insurance Company of North America301791Agent - Health  
DeniedAllianz Life Insurance Company of North America301791Agent - Life  
InactiveAmerican Family Life Assurance Company of Columbus (AFLAC)301781Agent - Health1/22/20041/31/2013
InactiveAmerican Family Life Assurance Company of Columbus (AFLAC)301781Agent - Life1/22/20041/31/2013
InactiveAmerican Fidelity Assurance Company301004Agent - Health8/5/200411/16/2004
InactiveAmerican Fidelity Assurance Company301004Agent - Life8/5/200411/16/2004
InactiveAmerican Heritage Life Insurance Company300272Agent - Health5/31/20013/31/2014
InactiveAmerican Heritage Life Insurance Company300272Agent - Life6/25/19923/31/2014
InactiveAmerican National Insurance Company301861Agent - Health5/31/20013/31/2014
InactiveAmerican National Insurance Company301861Agent - Life11/6/20003/31/2014
InactiveAnthem Health Plans of Kentucky, Inc.300999Agent - Health12/26/20013/31/2014
InactiveAnthem Insurance Companies, Inc.300941Agent - Health12/26/200110/16/2012
InactiveAnthem Life Insurance Company301209Agent - Health5/31/20013/31/2014
InactiveAnthem Life Insurance Company301209Agent - Life7/28/19993/31/2014
InactiveAthene Annuity & Life Assurance Company301798Agent - Health5/31/20015/31/2007
InactiveAthene Annuity & Life Assurance Company301798Agent - Life8/2/19955/31/2007
InactiveAugustar Life Assurance Corporation301113Agent - Health11/10/200411/9/2009
InactiveAugustar Life Assurance Corporation301113Agent - Life11/10/200411/9/2009
InactiveAugustar Life Insurance Company301816Agent - Health11/10/200411/9/2009
InactiveAugustar Life Insurance Company301816Agent - Life11/10/200411/9/2009
InactiveBaltasVision, LLC598376Agent - Health12/13/20043/31/2014
InactiveBankers United Life Assurance Company300296Agent - Health2/27/19965/5/1999
InactiveBankers United Life Assurance Company300296Agent - Life2/27/19965/5/1999
InactiveBanner Life Insurance Company301696Agent - Life7/30/20033/31/2014
InactiveBaptist Health Plan, Inc.300157Agent - Health3/27/20033/31/2014
InactiveBerkshire Life Insurance Company301158Agent - Health8/7/20007/1/2001
InactiveBerkshire Life Insurance Company301158Agent - Life8/7/20007/1/2001
InactiveBerkshire Life Insurance Company of America300983Agent - Health6/27/200112/12/2012
InactiveBerkshire Life Insurance Company of America300983Agent - Life6/27/200112/12/2012
InactiveBoston Mutual Life Insurance Company300143Agent - Health5/31/20011/30/2009
InactiveBoston Mutual Life Insurance Company300143Agent - Life1/31/19961/30/2009
InactiveCanada Life Assurance Company301192Agent - Health5/22/20007/27/2004
InactiveCanada Life Assurance Company301192Agent - Life5/22/20007/27/2004
InactiveColonial Life and Accident Insurance Company300846Agent - Health1/9/200812/21/2012
InactiveColonial Life and Accident Insurance Company300846Agent - Life1/9/200812/21/2012
InactiveCompBenefits Dental, Inc.591692Agent - Health1/10/200511/27/2006
InactiveCompBenefits Insurance Company301864Agent - Health3/22/200411/27/2006
InactiveCompBenefits Insurance Company301864Agent - Life3/22/200411/27/2006
InactiveCompDent Corporation301387Agent - Health3/22/200412/23/2004
InactiveContinental Casualty Company301019Agent - Health5/31/200111/29/2004
InactiveDearborn Life Insurance Company300401Agent - Health12/31/200412/28/2009
InactiveDearborn Life Insurance Company300401Agent - Life12/31/200412/28/2009
InactiveDental Concern Inc. (The)301641Agent - Health3/21/20095/23/2009
InactiveFidelity & Guaranty Life Insurance Company301359Agent - Life8/7/20039/4/2008
InactiveFirst Colony Life Insurance Company301179Agent - Health5/31/20011/1/2007
InactiveFirst Colony Life Insurance Company301179Agent - Life1/8/20011/1/2007
InactiveGenworth Life Insurance Company300623Agent - Health5/30/200810/18/2012
InactiveGenworth Life Insurance Company300623Agent - Life5/30/200810/18/2012
InactiveGenworth Life and Annuity Insurance Company301276Agent - Health5/31/200110/18/2012
InactiveGenworth Life and Annuity Insurance Company301276Agent - Life6/25/199210/18/2012
InactiveGerber Life Insurance Company300529Agent - Health1/6/20123/31/2014
InactiveGerber Life Insurance Company300529Agent - Life1/16/20123/31/2014
InactiveGolden Rule Insurance Company301943Agent - Health10/18/200512/21/2005
InactiveGolden Rule Insurance Company301943Agent - Life10/18/200512/21/2005
InactiveGuarantee Life Insurance Company301560Agent - Health3/25/19969/8/2000
InactiveGuarantee Life Insurance Company301560Agent - Life3/25/19969/8/2000
InactiveGuardian Life Insurance Company of America301316Agent - Health5/31/200112/12/2012
InactiveGuardian Life Insurance Company of America301316Agent - Life12/27/199912/12/2012
InactiveHCC Life Insurance Company301827Agent - Health12/13/20058/24/2009
InactiveHCC Life Insurance Company301827Agent - Life12/13/20058/24/2009
InactiveHartford Life Group Insurance Company301708Agent - Health4/9/200412/31/2006
InactiveHartford Life Group Insurance Company301708Agent - Life4/9/200412/31/2006
InactiveHartford Life and Accident Insurance Company300878Agent - Health4/14/20033/31/2014
InactiveHartford Life and Accident Insurance Company300878Agent - Life4/14/20033/31/2014
InactiveHealth Resources Inc.301210Agent - Health5/31/20013/31/2014
InactiveHealth Resources Inc.301210Agent - Prepaid Dental Plan12/9/19983/1/2001
InactiveHumana Health Plan, Inc.300142Agent - Health5/31/20015/23/2009
InactiveHumana Health Plan, Inc.300142Agent - Health Maintenance Organization8/12/19983/1/2001
InactiveHumana Insurance Company301104Agent - Health5/31/20015/23/2009
InactiveHumana Insurance Company301104Agent - Life8/12/19985/23/2009
InactiveHumana Insurance Company of Kentucky300826Agent - Health1/30/20045/23/2009
InactiveHumana Insurance Company of Kentucky300826Agent - Life1/30/20045/23/2009
InactiveHumanaDental Insurance Company301457Agent - Health8/8/20085/23/2009
InactiveHumanaDental Insurance Company301457Agent - Life8/8/20085/23/2009
InactiveIllinois Mutual Life Insurance Company301479Agent - Health7/13/200512/28/2006
InactiveIllinois Mutual Life Insurance Company301479Agent - Life7/13/200512/28/2006
InactiveImperium Insurance Company300804Agent - Health8/11/200410/16/2012
InactiveJefferson Pilot Financial Insurance Company300756Agent - Health5/31/20017/2/2007
InactiveJefferson Pilot Financial Insurance Company300756Agent - Life9/8/20007/2/2007
InactiveJefferson-Pilot Life Insurance Company300379Agent - Health5/31/19953/13/1997
InactiveJefferson-Pilot Life Insurance Company300379Agent - Life5/31/19953/13/1997
InactiveJohn Alden Life Insurance Company300573Agent - Health5/31/200111/14/2006
InactiveJohn Alden Life Insurance Company300573Agent - Life1/22/200111/14/2006
InactiveJohn Hancock Life Insurance Company300821Agent - Health11/24/200412/30/2009
InactiveJohn Hancock Life Insurance Company300821Agent - Life11/24/200412/30/2009
InactiveJohn Hancock Life Insurance Company (U.S.A.)300132Agent - Health9/19/20083/31/2014
InactiveJohn Hancock Life Insurance Company (U.S.A.)300132Agent - Life9/19/20083/31/2014
InactiveJohn Hancock Variable Life Insurance Company301914Agent - Life11/24/20042/24/2009
InactiveLafayette Life Insurance Company (The)301039Agent - Health5/31/20018/3/2009
InactiveLafayette Life Insurance Company (The)301039Agent - Life6/5/19988/3/2009
InactiveLincoln Benefit Life Company301110Agent - Life3/13/19963/31/2014
InactiveLincoln National Life Insurance Company (The)301382Agent - Health7/2/20077/31/2012
InactiveLincoln National Life Insurance Company (The)301382Agent - Life7/2/20077/31/2012
InactiveMedAmerica Insurance Company301568Agent - Health8/10/20066/23/2010
InactiveMedical Life Insurance Company300693Agent - Health5/31/200112/31/2004
InactiveMedical Life Insurance Company300693Agent - Life12/9/199712/31/2004
InactiveMetropolitan Life Insurance Company301948Agent - Health6/17/200311/27/2009
InactiveMetropolitan Life Insurance Company301948Agent - Life6/17/200311/27/2009
InactiveMutual of Omaha Insurance Company301012Agent - Health5/31/200112/26/2012
InactiveNational Guardian Life Insurance Company300596Agent - Health4/9/20043/26/2007
InactiveNational Guardian Life Insurance Company300596Agent - Life4/9/20043/26/2007
InactiveOmaha Insurance Company751908Agent - Health6/8/20126/24/2013
InactivePaul Revere Life Insurance Company300971Agent - Health5/31/200111/21/2005
InactivePaul Revere Life Insurance Company300971Agent - Life2/14/199811/21/2005
InactivePenn Treaty Network America Insurance Company301297Agent - Health7/6/19997/1/2002
InactivePenn Treaty Network America Insurance Company301297Agent - Life7/6/19997/1/2002
InactivePrincipal Life Insurance Company300129Agent - Health5/31/20013/31/2014
InactivePrincipal Life Insurance Company300129Agent - Life6/25/19923/31/2014
InactiveProgressive Max Insurance Company301034Agent - Casualty8/15/20009/18/2007
InactiveProgressive Max Insurance Company301034Agent - General Lines4/10/20008/15/2000
InactiveProgressive Max Insurance Company301034Agent - Property8/15/20009/18/2007
InactiveProgressive Northern Insurance Company301378Agent - Casualty8/15/20009/18/2007
InactiveProgressive Northern Insurance Company301378Agent - General Lines2/3/20008/15/2000
InactiveProgressive Northern Insurance Company301378Agent - Property8/15/20009/18/2007
InactiveProgressive Northwestern Insurance Company300441Agent - Casualty8/15/200012/28/2005
InactiveProgressive Northwestern Insurance Company300441Agent - General Lines4/10/20008/15/2000
InactiveProgressive Northwestern Insurance Company300441Agent - Property8/15/200012/28/2005
InactiveProtective Life Insurance Company300638Agent - Health11/25/199712/15/2003
InactiveProtective Life Insurance Company300638Agent - Life11/25/199712/15/2003
InactiveProvident Life and Accident Insurance Company301525Agent - Health5/31/200111/21/2005
InactiveProvident Life and Accident Insurance Company301525Agent - Life10/4/199311/21/2005
InactivePruco Life Insurance Company300954Agent - Health3/1/20086/27/2013
InactivePruco Life Insurance Company300954Agent - Life3/10/20086/27/2013
InactivePrudential Insurance Company of America300784Agent - Health12/31/20086/26/2013
InactivePrudential Insurance Company of America300784Agent - Life12/31/20086/26/2013
InactiveQBE Insurance Corporation300515Agent - Health10/15/20023/31/2014
InactiveReassure America Life Insurance Company301902Agent - Health5/31/20019/20/2004
InactiveReassure America Life Insurance Company301902Agent - Life11/7/19969/20/2004
InactiveSecurity Life Insurance Company of America300936Agent - Health10/26/199811/5/2001
InactiveSecurity Life Insurance Company of America300936Agent - Life10/26/199811/5/2001
InactiveStandard Life and Accident Insurance Company301534Agent - Health8/2/20123/31/2014
InactiveTransamerica Assurance Company300893Agent - Health3/25/19937/27/2004
InactiveTransamerica Assurance Company300893Agent - Life3/25/19937/27/2004
InactiveTransamerica Life Insurance Company300571Agent - Health3/25/20135/29/2013
InactiveTransamerica Life Insurance Company300571Agent - Life3/25/20135/29/2013
InactiveTransamerica Life Insurance and Annuity Company300148Agent - Life8/15/199610/1/2005
InactiveTransamerica Occidental Life Insurance Company300966Agent - Health5/31/200110/1/2008
InactiveTransamerica Occidental Life Insurance Company300966Agent - Life6/25/199210/1/2008
InactiveU.S. Financial Life Insurance Company301812Agent - Health5/31/20019/13/2007
InactiveU.S. Financial Life Insurance Company301812Agent - Life2/26/20019/13/2007
InactiveUNUM Life Insurance Company of America300817Agent - Health5/31/200111/29/2005
InactiveUNUM Life Insurance Company of America300817Agent - Life12/30/199711/29/2005
InactiveUnion Security Insurance Company301844Agent - Health2/7/200211/24/2003
InactiveUnion Security Insurance Company301844Agent - Life2/7/200211/24/2003
InactiveUnited World Life Insurance Company300532Agent - Health7/10/200712/15/2010
InactiveUnited of Omaha Life Insurance Company300156Agent - Health8/22/200612/26/2012
InactiveUnited of Omaha Life Insurance Company300156Agent - Life8/22/200612/26/2012
InactiveUnitedHealthcare Insurance Company300946Agent - Health2/28/20083/31/2014
InactiveUnitedHealthcare Insurance Company300946Agent - Life2/28/20083/31/2014
InactiveUnitedHealthcare of Kentucky, Ltd.301337Agent - Health2/28/20083/31/2014
InactiveUnitedHealthcare of Kentucky, Ltd.301337Agent - Health Maintenance Organization12/21/19993/1/2001
InactiveUnitedHealthcare of Ohio, Inc.300493Agent - Health2/28/20083/31/2014
InactiveWest Coast Life Insurance Company301607Agent - Health8/21/200712/13/2011
InactiveWest Coast Life Insurance Company301607Agent - Life8/21/200712/13/2011
InactiveWilcac Life Insurance Company301573Agent - Health11/21/199511/13/2000
InactiveWilcac Life Insurance Company301573Agent - Life11/21/199511/13/2000
Inactive300277Agent - Life1/29/200112/10/2004
Designated Individuals
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveAcordia of Louisville Inc.401252Agent - Health7/1/199312/31/2001
InactiveAcordia of Louisville Inc.401252Agent - Life7/1/199312/31/2001
InactiveBaltas, Jeffrey Thomas Rex 589880Administrator - Not Applicable6/4/20123/31/2014
InactiveBaltas, Jeffrey Thomas Rex 589880Agent - Health6/10/20103/31/2014
InactiveBaltas, Jeffrey Thomas Rex 589880Agent - Life6/10/20107/17/2013
InactiveBickley, Joseph Michael 507045Agent - Health2/25/20089/17/2008
InactiveBickley, Joseph Michael 507045Agent - Life2/25/20089/17/2008
InactiveBlack, Matthew Franklin 330762Agent - Health8/5/19992/28/2006
InactiveBlack, Matthew Franklin 330762Agent - Life8/5/19992/28/2006
InactiveDavis, Timothy Ray 367724Administrator - Not Applicable2/11/19933/31/2014
InactiveDavis, Timothy Ray 367724Agent - Casualty8/15/20003/31/2014
InactiveDavis, Timothy Ray 367724Agent - General Lines2/3/20008/15/2000
InactiveDavis, Timothy Ray 367724Agent - Health8/15/19883/31/2014
InactiveDavis, Timothy Ray 367724Agent - Life6/25/19923/31/2014
InactiveDavis, Timothy Ray 367724Agent - Property8/15/20003/31/2014
InactiveGibson, Pamela Jean 349050Administrator - Not Applicable7/27/19983/31/2014
InactiveGoodman, Bradley Keith 662533Agent - Health2/25/20086/4/2012
InactiveGoodman, Bradley Keith 662533Agent - Life3/18/20086/4/2012
InactiveGregory, Debra Brooke 551882Administrator - Not Applicable6/4/20123/31/2014
InactiveGregory, Debra Brooke 551882Agent - Health1/13/20053/31/2014
InactiveGregory, Debra Brooke 551882Agent - Life1/13/20053/31/2014
InactiveMajor, Thomas C 328592Administrator - Not Applicable7/27/19987/12/2005
InactiveMajor, Thomas C 328592Agent - Health8/5/19991/22/2007
InactiveMajor, Thomas C 328592Agent - Life8/5/19991/22/2007
InactiveMartin, Diana L 324247Agent - Casualty8/15/20003/31/2010
InactiveMartin, Diana L 324247Agent - General Lines2/3/20008/15/2000
InactiveMartin, Diana L 324247Agent - Property8/15/20003/31/2010
InactiveNecessary, Christopher Scott 636428Agent - Health9/19/200610/27/2010
InactiveNecessary, Christopher Scott 636428Agent - Life9/19/200610/27/2010
InactiveOwsley, Thomas M 362198Agent - Health8/23/199910/24/2008
InactiveOwsley, Thomas M 362198Agent - Life8/23/199910/24/2008
InactiveSanborn, Marc 593028Agent - Health1/13/20059/17/2008
InactiveSanborn, Marc 593028Agent - Life3/28/20089/17/2008
InactiveSpeck, Royce Allen 360854Agent - Health8/5/19996/4/2012
InactiveSpeck, Royce Allen 360854Agent - Life8/5/19996/4/2012
DeniedVanderbilt-Shifflet, Cari Sue 623269Agent - Health  
DeniedVanderbilt-Shifflet, Cari Sue 623269Agent - Life  
InactiveWood, Anna Marie 364292Agent - Health10/6/19982/18/2003
InactiveWood, Anna Marie 364292Agent - Life10/6/19982/18/2003
Designated to act on behalf of the following Business Entities
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveArison Insurance Services, Inc.401001Agent - Health7/19/199912/31/2001
InactiveArison Insurance Services, Inc.401001Agent - Life7/19/199912/31/2001

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