DEPARTMENT OF INSURANCE

Affiliations

Name	Hollingsworth, Jack E	DOIID	716816	NAIC NPN	13454188

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Life	10/27/2009	6/30/2012
Inactive	Non Resident	Agent	Health	10/27/2009	6/30/2012
* 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	2/11/2010	6/30/2012
Inactive	Aetna Life Insurance Company	301140	Agent - Health	2/11/2010	6/30/2012
Inactive	Aetna Life Insurance Company	301140	Agent - Life	2/11/2010	6/30/2012
Inactive	Anthem Life Insurance Company	301209	Agent - Health	2/16/2011	6/30/2012
Inactive	Anthem Life Insurance Company	301209	Agent - Life	2/16/2011	6/30/2012
Inactive	Colorado Bankers Life Insurance Company	301845	Agent - Health	11/30/2010	1/3/2012
Inactive	Colorado Bankers Life Insurance Company	301845	Agent - Life	11/30/2010	1/3/2012
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	8/18/2010	6/30/2012
Inactive	CompBenefits Insurance Company	301864	Agent - Health	8/18/2010	11/22/2011
Inactive	CompBenefits Insurance Company	301864	Agent - Life	8/18/2010	11/22/2011
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	8/18/2010	6/30/2012
Inactive	Golden Rule Insurance Company	301943	Agent - Health	11/19/2009	6/30/2012
Inactive	Golden Rule Insurance Company	301943	Agent - Life	11/19/2009	6/30/2012
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	8/18/2010	6/30/2012
Inactive	Humana Insurance Company	301104	Agent - Health	8/18/2010	6/30/2012
Inactive	Humana Insurance Company	301104	Agent - Life	8/18/2010	6/30/2012
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	8/18/2010	6/30/2012
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	8/18/2010	6/30/2012
Inactive	Kanawha Insurance Company	300127	Agent - Health	8/18/2010	6/30/2012
Inactive	Kanawha Insurance Company	300127	Agent - Life	8/18/2010	6/30/2012
Inactive	Time Insurance Company	300683	Agent - Health	11/30/2009	8/8/2012
Inactive	Time Insurance Company	300683	Agent - Life	11/30/2009	8/8/2012
Inactive	World Insurance Company	300396	Agent - Health	4/23/2010	11/29/2010
Inactive	World Insurance Company	300396	Agent - Life	4/23/2010	11/29/2010

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	2/16/2011	6/30/2012
Inactive	Designated Agent Company Inc.	681257	Agent - Health	2/16/2011	6/30/2012