DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Bass, Mouzon	DOIID	741424	NAIC NPN	1091341

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Administrator	Not Applicable	2/10/2021	9/30/2025
Inactive	Non Resident	Agent	Life	11/27/2019	9/30/2025
Inactive	Non Resident	Agent	Health	11/27/2019	9/30/2025
* 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	Arch Insurance Company	300688	Agent - Health	4/18/2012	6/21/2012
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Health	8/12/2011	10/10/2015
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Life	8/12/2011	10/10/2015
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Health	1/8/2020	6/25/2024
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Life	1/8/2020	6/25/2024
Inactive	Guardian Insurance & Annuity Company Inc. (The)	301920	Agent - Life	8/12/2011	10/10/2015
Inactive	Guardian Life Insurance Company of America	301316	Agent - Health	8/12/2011	10/10/2015
Inactive	Guardian Life Insurance Company of America	301316	Agent - Life	8/12/2011	10/10/2015
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	1/15/2020	10/31/2025
Inactive	United World Life Insurance Company	300532	Agent - Health	1/15/2020	10/31/2025
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	1/15/2020	10/31/2025
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	1/15/2020	10/31/2025

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Ebenconcepts Co	955223	Agent - Life	6/1/2020	2/16/2024
Inactive	Ebenconcepts Co	955223	Agent - Health	6/1/2020	2/16/2024
Inactive	Employers Direct Health Inc	744503	Administrator - Not Applicable	2/12/2021	1/28/2025