DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Allied Benefit Systems, LLC	DOIID	665231	NAIC NPN	23442

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Administrator	Not Applicable	10/19/2007		3/31/2027
Active	Non Resident	Agent	Health	10/3/2007		3/31/2027
Inactive	Non Resident	Agent	Life	10/3/2007	4/18/2024
* 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
Active	Berkshire Hathaway Specialty Insurance Company	300908	Agent - Health	5/28/2024
Inactive	HCC Life Insurance Company	301827	Agent - Health	3/28/2008	12/6/2010
Inactive	HCC Life Insurance Company	301827	Agent - Life	3/28/2008	12/6/2010
Active	Nationwide Life Insurance Company	300495	Agent - Health	4/5/2024
Inactive	Nationwide Life Insurance Company	300495	Agent - Life	4/5/2024	4/18/2024
Active	QBE Insurance Corporation	300515	Agent - Health	3/30/2015
Inactive	Standard Security Life Insurance Company of NY	301487	Agent - Health	3/7/2016	12/26/2018
Active	Swiss Re Corporate Solutions America Insurance Corporation	300338	Agent - Health	5/11/2021
Inactive	Westport Insurance Corporation	301875	Agent - Health	3/7/2016	4/20/2023

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	DeClark, David Charles	1218786	Administrator - Not Applicable	8/19/2022	2/4/2026
Inactive	Jacob, Jeri L	651945	Agent - Health	10/3/2007	4/18/2024
Inactive	Jacob, Jeri L	651945	Agent - Life	10/3/2007	4/18/2024
Denied	Mccarthy, Dan T	1328662	Agent - Health
Active	Purtell, Jocelyn Patrice	1445757	Administrator - Not Applicable	2/4/2026
Active	Rozmiarek, Andrew Scott	1157994	Agent - Health	4/18/2024
Inactive	Wilneff, Mitchell David	665767	Administrator - Not Applicable	10/19/2007	8/19/2022