DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Tri-State Senior Solutions Inc	DOIID	729041	NAIC NPN	8659060

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	6/8/2010	3/31/2012
Inactive	Non Resident	Agent	Health	6/8/2010	3/31/2012
Denied	Non Resident	Life & Health Consultant	Not Applicable
Denied	Non Resident	Property & Casualty Consultant	Not Applicable
* 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	American Equity Investment Life Insurance Company	300389	Agent - Life	6/14/2010	10/19/2011
Inactive	Gerber Life Insurance Company	300529	Agent - Health	6/17/2010	8/26/2011
Inactive	Loyal American Life Insurance Company	301172	Agent - Health	8/4/2010	12/9/2010
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	6/17/2010	8/26/2011
Inactive	United Teacher Associates Insurance Company	300747	Agent - Health	8/4/2010	12/9/2010
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	6/17/2010	8/26/2011
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	6/17/2010	8/26/2011

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Scott, Shannon K	591413	Agent - Health	6/8/2010	3/31/2012
Inactive	Scott, Shannon K	591413	Agent - Life	6/8/2010	3/31/2012