DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Burnworth, Pamela	DOIID	780355	NAIC NPN	8971261

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	4/26/2012	1/31/2016
Inactive	Non Resident	Agent	Life	4/26/2012	1/31/2016
* 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	Anthem Life Insurance Company	301209	Agent - Health	5/23/2012	2/25/2016
Inactive	Anthem Life Insurance Company	301209	Agent - Life	5/23/2012	2/25/2016
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	10/27/2015	1/31/2016
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	10/27/2015	1/31/2016
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	10/27/2015	1/31/2016
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	10/27/2015	1/31/2016
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	10/27/2015	1/31/2016
Inactive	Humana Insurance Company	301104	Agent - Health	10/27/2015	1/31/2016
Inactive	Humana Insurance Company	301104	Agent - Life	10/27/2015	1/31/2016
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	10/27/2015	1/31/2016
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	10/27/2015	1/31/2016
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	10/27/2015	1/31/2016

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 - Health	5/23/2012	2/25/2016
Inactive	Designated Agent Company Inc.	681257	Agent - Life	5/23/2012	2/25/2016
Inactive	USI Insurance Services National, Inc	509421	Agent - Health	5/23/2012	5/29/2014
Inactive	USI Insurance Services National, Inc	509421	Agent - Life	5/23/2012	5/29/2014
Inactive	USI Midwest LLC	517736	Agent - Health	6/5/2014	8/21/2015
Inactive	USI Midwest LLC	517736	Agent - Life	6/5/2014	8/21/2015