DEPARTMENT OF INSURANCE

Affiliations

Name	Lifetime Benefit Solutions, Inc.	DOIID	574373	NAIC NPN	2329259

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Administrator	Not Applicable	6/27/2024		3/31/2027
Active	Non Resident	Agent	Life	11/11/2013		3/31/2027
Active	Non Resident	Agent	Health	11/11/2013		3/31/2027
Inactive	Non Resident	Agent	Property	8/8/2003	7/1/2006
Inactive	Non Resident	Agent	Casualty	8/8/2003	7/1/2006
* 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	ACE American Insurance Company	300625	Agent - Casualty	3/23/2005	7/1/2006
Inactive	ACE American Insurance Company	300625	Agent - Property	3/23/2005	7/1/2006
Inactive	ACE Fire Underwriters Insurance Company	301679	Agent - Casualty	3/23/2005	7/1/2006
Inactive	ACE Fire Underwriters Insurance Company	301679	Agent - Property	3/23/2005	7/1/2006
Inactive	Hartford Accident and Indemnity Company	301917	Agent - Casualty	8/8/2003	7/1/2006
Inactive	Hartford Accident and Indemnity Company	301917	Agent - Property	8/8/2003	7/1/2006
Inactive	Hartford Casualty Insurance Company	301332	Agent - Casualty	8/8/2003	7/1/2006
Inactive	Hartford Casualty Insurance Company	301332	Agent - Property	8/8/2003	7/1/2006
Inactive	Hartford Fire Insurance Company	300628	Agent - Casualty	8/8/2003	7/1/2006
Inactive	Hartford Fire Insurance Company	300628	Agent - Property	8/8/2003	7/1/2006
Inactive	Hartford Insurance Company of the Midwest	301918	Agent - Casualty	8/8/2003	7/1/2006
Inactive	Hartford Insurance Company of the Midwest	301918	Agent - Property	8/8/2003	7/1/2006
Inactive	Hartford Life Group Insurance Company	301708	Agent - Health	5/10/2005	12/31/2006
Inactive	Hartford Life Group Insurance Company	301708	Agent - Life	5/10/2005	12/31/2006
Active	Hartford Life and Accident Insurance Company	300878	Agent - Health	11/15/2013
Active	Hartford Life and Accident Insurance Company	300878	Agent - Life	11/15/2013
Inactive	Hartford Underwriters Insurance Company	301064	Agent - Casualty	8/8/2003	7/1/2006
Inactive	Hartford Underwriters Insurance Company	301064	Agent - Property	8/8/2003	7/1/2006
Inactive	Property and Casualty Insurance Company of Hartford	301409	Agent - Casualty	5/25/2005	7/1/2006
Inactive	Property and Casualty Insurance Company of Hartford	301409	Agent - Property	5/25/2005	7/1/2006
Inactive	Sentinel Insurance Company, Limited	501696	Agent - Casualty	2/2/2005	7/1/2006
Inactive	Sentinel Insurance Company, Limited	501696	Agent - Property	2/2/2005	7/1/2006
Inactive	Trumbull Insurance Company	300242	Agent - Casualty	5/25/2005	7/1/2006
Inactive	Trumbull Insurance Company	300242	Agent - Property	5/25/2005	7/1/2006
Inactive	Twin City Fire Insurance Company	300721	Agent - Casualty	8/8/2003	7/1/2006
Inactive	Twin City Fire Insurance Company	300721	Agent - Property	8/8/2003	7/1/2006

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Boothby, Brian	922232	Agent - Health	8/30/2016	7/31/2017
Denied	Boothby, Brian	922232	Agent - Life
Denied	Burgess, Lance N	1044044	Agent - Health
Inactive	Cauthorn, Thomas D	824720	Administrator - Not Applicable	11/13/2013	10/3/2018
Inactive	Cauthorn, Thomas D	824720	Agent - Health	11/11/2013	8/1/2018
Inactive	Cauthorn, Thomas D	824720	Agent - Life	11/11/2013	8/1/2018
Inactive	Dobroski, Debra S	998217	Administrator - Not Applicable	10/3/2018	9/6/2019
Inactive	Dobroski, Debra S	998217	Agent - Health	8/21/2018	9/6/2019
Inactive	Dobroski, Debra S	998217	Agent - Life	8/21/2018	9/6/2019
Inactive	Duffy, Brian J	598935	Agent - Casualty	1/18/2005	4/30/2006
Inactive	Duffy, Brian J	598935	Agent - Property	1/18/2005	4/30/2006
Inactive	Florack, Lori Marie	1016556	Administrator - Not Applicable	9/6/2019	7/31/2023
Inactive	Florack, Lori Marie	1016556	Agent - Health	9/6/2019	7/31/2023
Inactive	Florack, Lori Marie	1016556	Agent - Life	9/6/2019	7/31/2023
Active	George, Michele Elizabeth	1153286	Administrator - Not Applicable	6/27/2024
Active	George, Michele Elizabeth	1153286	Agent - Health	10/13/2023
Active	George, Michele Elizabeth	1153286	Agent - Life	10/13/2023
Inactive	Grucza, Douglas Andrew	816224	Administrator - Not Applicable	8/12/2013	11/13/2013
Inactive	Grucza, Douglas Andrew	816224	Agent - Health	11/11/2013	4/30/2015
Inactive	Grucza, Douglas Andrew	816224	Agent - Life	11/11/2013	4/30/2015
Inactive	Herendeen, Charles G	731881	Administrator - Not Applicable	3/22/2011	8/12/2013
Inactive	Herendeen, Charles G	731881	Agent - Health	12/27/2010	8/12/2013
Inactive	Herendeen, Charles G	731881	Agent - Life	12/27/2010	8/12/2013
Denied	McCarthy, Steven J	737336	Agent - Casualty
Denied	McCarthy, Steven J	737336	Agent - Property
Inactive	Osier, Joan M	603254	Administrator - Not Applicable	2/18/2009	12/31/2010
Inactive	Osier, Joan M	603254	Agent - Health	4/28/2005	12/27/2010
Inactive	Osier, Joan M	603254	Agent - Life	4/28/2005	12/27/2010
Inactive	Sykes, Richard H	574335	Agent - Casualty	8/8/2003	9/30/2005
Inactive	Sykes, Richard H	574335	Agent - Property	8/8/2003	9/30/2005