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	Health	11/11/2013		3/31/2027
Active	Non Resident	Agent	Life	11/11/2013		3/31/2027
Inactive	Non Resident	Agent	Casualty	8/8/2003	7/1/2006
Inactive	Non Resident	Agent	Property	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.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Administrator	01/15/2027	03/31/2027
Agent	01/15/2027	03/31/2027

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