DEPARTMENT OF INSURANCE

Affiliations

Name	Longevity LTC Inc	DOIID	655557	NAIC NPN	8675969

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Health	5/24/2007	3/31/2019
Inactive	Non Resident	Agent	Life	5/24/2007	3/31/2019
* 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	Genworth Life Insurance Company	300623	Agent - Health	12/8/2007	12/11/2018
Inactive	Genworth Life Insurance Company	300623	Agent - Life	12/8/2007	12/11/2018
Inactive	John Hancock Life Insurance Company	300821	Agent - Health	11/20/2007	12/30/2009
Inactive	John Hancock Life Insurance Company	300821	Agent - Life	11/20/2007	12/30/2009
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Health	9/19/2008	3/31/2019
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Life	9/19/2008	3/31/2019
Inactive	MedAmerica Insurance Company	301568	Agent - Health	12/4/2007	7/1/2014
Inactive	Metropolitan Life Insurance Company	301948	Agent - Health	11/30/2007	11/26/2009
Inactive	Metropolitan Life Insurance Company	301948	Agent - Life	11/30/2007	11/26/2009
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	7/29/2009	1/27/2014

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Bell, Cameron Dean	672648	Agent - Health
Denied	Bell, Cameron Dean	672648	Agent - Life
Inactive	Burke, Robert James	316901	Agent - Health	9/29/2008	2/28/2009
Inactive	Burke, Robert James	316901	Agent - Life	9/29/2008	2/28/2009
Inactive	Cassens, Bruce Keane	545973	Agent - Health	5/24/2007	3/31/2019
Inactive	Cassens, Bruce Keane	545973	Agent - Life	5/24/2007	3/31/2019
Denied	Dvorak, Christine Elizabeth	616996	Agent - Health
Inactive	Dvorak, Christine Elizabeth	616996	Agent - Life	10/8/2009	12/31/2009
Inactive	Gaughan, Charles Wilbur	687290	Agent - Health	10/8/2009	7/31/2012
Inactive	Gaughan, Charles Wilbur	687290	Agent - Life	10/8/2009	7/31/2012
Denied	Gordon, Kenneth Charles	707296	Agent - Health
Denied	Gordon, Kenneth Charles	707296	Agent - Life
Denied	Poulsen, Doris Elaine	675036	Agent - Health
Denied	Poulsen, Doris Elaine	675036	Agent - Life
Denied	Puma, Christopher Robert	702702	Agent - Health
Denied	Puma, Christopher Robert	702702	Agent - Life
Inactive	Smith, Leonard Stanley	506699	Agent - Health	5/24/2007	9/29/2008
Inactive	Smith, Leonard Stanley	506699	Agent - Life	5/24/2007	9/29/2008
Inactive	Tranzow, Karleton Lee	613842	Agent - Health	11/14/2008	6/12/2017
Inactive	Tranzow, Karleton Lee	613842	Agent - Life	11/14/2008	12/14/2016