DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	FISI Madison Financial Corp. DBA : Long Term Preferred Care, Inc.	DOIID	401291	NAIC NPN	3268436

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Administrator	Not Applicable	10/15/1993	3/4/2002
Inactive	Resident	Agent	General Lines	11/5/1992	8/15/2000
Inactive	Resident	Agent	Life	2/11/1997	10/24/2004
Inactive	Resident	Agent	Casualty	8/15/2000	12/27/2001
Inactive	Resident	Agent	Property	8/15/2000	12/27/2001
Inactive	Resident	Agent	Health	3/24/2000	10/24/2004
* 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	Allianz Life Insurance Company of North America	301791	Agent - Health	12/26/2001	10/24/2004
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	12/26/2001	10/24/2004
Inactive	Conseco Health Insurance Company	301725	Agent - Health	9/14/2001	8/20/2004
Inactive	Conseco Health Insurance Company	301725	Agent - Life	9/14/2001	8/20/2004
Inactive	Continental Casualty Company	301019	Agent - Casualty	8/15/2000	12/27/2001
Inactive	Continental Casualty Company	301019	Agent - General Lines	11/5/1992	8/15/2000
Inactive	Continental Casualty Company	301019	Agent - Property	8/15/2000	12/27/2001
Inactive	Genworth Life Insurance Company	300623	Agent - Health	4/25/2002	10/24/2004
Inactive	Genworth Life Insurance Company	300623	Agent - Life	4/25/2002	10/24/2004
Inactive	MassMutual Ascend Life Insurance Company	300320	Agent - Health	3/24/2000	12/24/2003
Inactive	MassMutual Ascend Life Insurance Company	300320	Agent - Life	1/4/2000	12/24/2003
Inactive	Senior Health Insurance Company of Pennsylvania	300251	Agent - Health	11/26/2001	11/19/2003
Inactive	Senior Health Insurance Company of Pennsylvania	300251	Agent - Life	11/26/2001	11/19/2003
Inactive	Western National Life Insurance Company	300461	Agent - Life	2/11/1997	10/24/2004

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Coblin, William Granville	391298	Agent - Casualty	8/15/2000	12/27/2001
Inactive	Coblin, William Granville	391298	Agent - General Lines	6/8/1994	8/15/2000
Inactive	Coblin, William Granville	391298	Agent - Health	6/8/1994	2/26/2003
Inactive	Coblin, William Granville	391298	Agent - Life	6/8/1994	2/26/2003
Inactive	Coblin, William Granville	391298	Agent - Property	8/15/2000	12/27/2001
Inactive	Ford, David Walter	308548	Agent - Health	6/13/2003	10/24/2004
Inactive	Ford, David Walter	308548	Agent - Life	6/13/2003	10/24/2004
Inactive	Pierce, Gary Lynn	308462	Administrator - Not Applicable	10/15/1993	3/4/2002
Inactive	Pierce, Gary Lynn	308462	Agent - Health	6/8/1994	3/1/2004
Inactive	Pierce, Gary Lynn	308462	Agent - Life	6/8/1994	3/1/2004