DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Olympic Health Management Services Inc	DOIID	509827	NAIC NPN	1627651

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	5/9/2000	3/31/2016
Inactive	Non Resident	Agent	Life	5/9/2000	3/31/2016
* 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	Conseco Insurance Company	301202	Agent - Health	8/30/2010	10/1/2010
Inactive	Conseco Insurance Company	301202	Agent - Life	8/30/2010	10/1/2010
Inactive	Madison National Life Insurance Company Inc.	301458	Agent - Health	5/25/2010	11/15/2013
Inactive	Madison National Life Insurance Company Inc.	301458	Agent - Life	5/25/2010	11/15/2013
Inactive	Standard Life and Accident Insurance Company	301534	Agent - Health	9/27/2001	9/29/2003
Inactive	Standard Life and Accident Insurance Company	301534	Agent - Life	9/27/2001	9/29/2003
Inactive	Sterling Life Insurance Company	301947	Agent - Health	5/9/2000	3/31/2016
Inactive	Sterling Life Insurance Company	301947	Agent - Life	5/9/2000	3/31/2016
Inactive	United American Insurance Company	300910	Agent - Health	4/21/2008	9/20/2012
Inactive	United American Insurance Company	300910	Agent - Life	4/21/2008	9/20/2012
Inactive	Washington National Insurance Company	300587	Agent - Health	10/1/2010	4/7/2014
Inactive	Washington National Insurance Company	300587	Agent - Life	10/1/2010	4/7/2014

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Chambers, David Lawrence	562447	Agent - Health	9/10/2015	3/31/2016
Inactive	Chambers, David Lawrence	562447	Agent - Life	9/10/2015	3/31/2016
Inactive	Collette, Karen Jane	514643	Agent - Health	7/10/2002	2/26/2003
Inactive	Collette, Karen Jane	514643	Agent - Life	7/10/2002	2/26/2003
Inactive	Gagnon, Michael Winthrop	505232	Agent - Health	5/9/2000	7/10/2002
Inactive	Gagnon, Michael Winthrop	505232	Agent - Life	5/9/2000	7/10/2002
Inactive	Mccoy, Melissa Annette	609325	Agent - Health	9/21/2005	3/31/2016
Inactive	Mccoy, Melissa Annette	609325	Agent - Life	9/21/2005	3/31/2016
Inactive	Ziegenfuss, Bonnie Joy	513865	Agent - Health	2/26/2003	6/30/2005
Inactive	Ziegenfuss, Bonnie Joy	513865	Agent - Life	2/26/2003	6/30/2005