DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Mousty, Mark Donald	DOIID	604144	NAIC NPN	969255

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	3/14/2005	4/2/2013
Inactive	Non Resident	Agent	Health	3/14/2005	4/2/2013
* 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	Anthem Life Insurance Company	301209	Agent - Health	9/20/2005	4/2/2013
Inactive	Anthem Life Insurance Company	301209	Agent - Life	9/20/2005	4/2/2013
Inactive	Baptist Health Plan, Inc.	300157	Agent - Health	9/2/2008	4/2/2013
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	10/22/2010	7/6/2012
Inactive	CompBenefits Insurance Company	301864	Agent - Health	10/22/2010	11/28/2011
Inactive	CompBenefits Insurance Company	301864	Agent - Life	10/22/2010	11/28/2011
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	10/22/2010	7/6/2012
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	10/22/2010	7/6/2012
Inactive	Humana Insurance Company	301104	Agent - Health	10/22/2010	7/6/2012
Inactive	Humana Insurance Company	301104	Agent - Life	10/22/2010	7/6/2012
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	11/4/2011	7/6/2012
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	11/4/2011	7/6/2012
Inactive	Kanawha Insurance Company	300127	Agent - Health	4/27/2012	7/6/2012
Inactive	Kanawha Insurance Company	300127	Agent - Life	4/27/2012	7/6/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Arison Insurance Services, Inc.	401001	Agent - Health	9/20/2005	6/23/2008
Inactive	Arison Insurance Services, Inc.	401001	Agent - Life	9/20/2005	6/23/2008
Inactive	Designated Agent Company Inc.	681257	Agent - Health	6/24/2008	4/2/2013
Inactive	Designated Agent Company Inc.	681257	Agent - Life	6/24/2008	4/2/2013