DEPARTMENT OF INSURANCE

Affiliations

Name	Stevens, Jack A	DOIID	661557	NAIC NPN	5457733

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Life	3/11/2013	2/5/2014
Inactive	Non Resident	Agent	Health	3/11/2013	2/5/2014
* 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	Aetna Health Inc. (PA)	660717	Agent - Health	10/12/2009	1/31/2012
Inactive	Aetna Life Insurance Company	301140	Agent - Health	10/12/2009	1/31/2012
Inactive	Aetna Life Insurance Company	301140	Agent - Life	10/12/2009	1/31/2012
Inactive	CIGNA Health & Life Insurance Company	301783	Agent - Health	9/18/2013	2/5/2014
Inactive	CIGNA Health & Life Insurance Company	301783	Agent - Life	9/18/2013	2/5/2014
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	11/5/2013	3/13/2014
Inactive	Connecticut General Life Insurance Company	301333	Agent - Health	11/10/2008	1/20/2011
Inactive	Connecticut General Life Insurance Company	301333	Agent - Life	9/28/2010	1/20/2011
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	11/5/2013	3/13/2014
Inactive	First Health Life & Health Insurance Company	301735	Agent - Health	9/13/2011	1/31/2012
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	9/17/2013	3/13/2014
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	9/17/2013	3/13/2014
Inactive	Humana Insurance Company	301104	Agent - Health	9/17/2013	3/13/2014
Inactive	Humana Insurance Company	301104	Agent - Life	9/17/2013	3/13/2014
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	9/17/2013	3/13/2014
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	9/17/2013	3/13/2014
Inactive	Kanawha Insurance Company	300127	Agent - Health	11/5/2013	3/13/2014
Inactive	Kanawha Insurance Company	300127	Agent - Life	11/5/2013	3/13/2014
Inactive	PacifiCare Life and Health Insurance Company	301304	Agent - Health	1/10/2008	8/5/2011
Inactive	Sterling Life Insurance Company	301947	Agent - Health	10/21/2009	8/12/2010
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	10/15/2009	1/31/2012
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	10/15/2009	1/31/2012
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	8/21/2013	2/5/2014
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	8/21/2013	2/5/2014

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Designated Agent Company Inc.	681257	Agent - Life	12/16/2013	2/5/2014
Inactive	Designated Agent Company Inc.	681257	Agent - Health	12/16/2013	2/5/2014
Inactive	Extend Insurance Services, LLC	625753	Agent - Life	10/12/2009	1/31/2012
Inactive	Extend Insurance Services, LLC	625753	Agent - Health	10/6/2009	1/31/2012