DEPARTMENT OF INSURANCE

Affiliations

Name	Thornburg, Jeffrey Scott	DOIID	716193	NAIC NPN	5590888

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Administrator	Not Applicable	11/24/2009		7/31/2026
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Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Med Cost Benefit Services LLC	716194	Administrator - Not Applicable	11/24/2009
Active	Usi Insurance Services LLC	669260	Administrator - Not Applicable	2/22/2018