DEPARTMENT OF INSURANCE

Affiliations

Name	Larson, Gordon J	DOIID	763254	NAIC NPN	16371802

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	9/12/2011	12/31/2016
* 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	10/16/2015	12/31/2016
Inactive	Aetna Life Insurance Company	301140	Agent - Health	10/16/2015	12/31/2016
Inactive	Bankers Fidelity Assurance Company	554627	Agent - Health	9/28/2015	4/4/2016
Inactive	Bankers Fidelity Life Insurance Company	300193	Agent - Health	9/28/2015	4/4/2016
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	10/16/2015	12/2/2016
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	10/16/2015	12/30/2016
Inactive	First Health Life & Health Insurance Company	301735	Agent - Health	10/16/2015	12/31/2016
Inactive	HCC Life Insurance Company	301827	Agent - Health	9/29/2015	10/3/2016
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	10/13/2014	10/2/2015
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	10/10/2012	10/2/2015
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	10/17/2015	11/11/2016
Inactive	Humana Insurance Company	301104	Agent - Health	1/26/2016	11/11/2016
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	10/17/2015	12/30/2016
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	10/13/2014	10/2/2015
Inactive	Humana Wisconsin Health Organization Insurance Corporation	830687	Agent - Health	10/12/2016	12/30/2016
Inactive	HumanaDental Insurance Company	301457	Agent - Health	11/16/2011	2/23/2012
Inactive	Kanawha Insurance Company	300127	Agent - Health	9/26/2011	10/2/2015
Inactive	SilverScript Insurance Company	663526	Agent - Health	10/15/2015	12/31/2016
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	11/19/2015	3/7/2016
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	11/19/2015	3/7/2016
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	11/19/2015	3/7/2016

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Humana MarketPOINT Inc.	398092	Agent - Health	10/19/2011	10/2/2015