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
Active	Non Resident	Administrator	Not Applicable	2/10/2021		9/30/2025
Active	Non Resident	Agent	Life	11/27/2019		9/30/2025
Active	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.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Administrator	07/15/2025	09/30/2025
Agent	07/15/2025	09/30/2025

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
Active	Mutual of Omaha Insurance Company	301012	Agent - Health	1/15/2020
Active	United World Life Insurance Company	300532	Agent - Health	1/15/2020
Active	United of Omaha Life Insurance Company	300156	Agent - Health	1/15/2020
Active	United of Omaha Life Insurance Company	300156	Agent - Life	1/15/2020

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