DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Long, Alisa C	DOIID	523731	NAIC NPN	1496873

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	6/25/2020	4/30/2022
Inactive	Non Resident	Agent	Health	6/25/2020	4/30/2022
* 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	Athene Annuity & Life Assurance Company	301798	Agent - Health	11/4/2009	4/30/2012
Inactive	Athene Annuity & Life Assurance Company	301798	Agent - Life	11/4/2009	4/30/2012
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	3/21/2009	8/31/2011
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	4/10/2001	8/31/2011
Inactive	Humana Insurance Company	301104	Agent - Health	4/10/2001	8/31/2011
Inactive	Humana Insurance Company	301104	Agent - Life	4/10/2001	8/31/2011
Inactive	Kanawha Insurance Company	300127	Agent - Health	4/11/2008	8/31/2011
Inactive	Kanawha Insurance Company	300127	Agent - Life	4/11/2008	8/31/2011
Inactive	Nippon Life Insurance Company of America	300446	Agent - Health	6/16/2009	4/30/2012
Inactive	Nippon Life Insurance Company of America	300446	Agent - Life	6/16/2009	4/30/2012
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	5/21/2004	4/30/2012
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	5/21/2004	4/30/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Willis Life Insurance Agency of Ohio, Inc.	536486	Agent - Health	10/1/2001	3/23/2009
Inactive	Willis Life Insurance Agency of Ohio, Inc.	536486	Agent - Life	10/1/2001	3/23/2009
Inactive	Willis Towers Watson Midwest, Inc.	534348	Agent - Health	5/8/2009	7/2/2010
Inactive	Willis Towers Watson Midwest, Inc.	534348	Agent - Life	5/8/2009	7/2/2010