DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Hollingsworth, Emily A	DOIID	787894	NAIC NPN	14277911

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Property	8/8/2012	5/31/2016
Inactive	Non Resident	Agent	Life	8/8/2012	5/31/2016
Inactive	Non Resident	Agent	Health	8/8/2012	5/31/2016
Inactive	Non Resident	Agent	Casualty	8/8/2012	5/31/2016
* 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	8/30/2012	5/31/2016
Inactive	Anthem Life Insurance Company	301209	Agent - Life	8/30/2012	5/31/2016
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	10/31/2012	4/14/2014
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	10/31/2012	4/14/2014
Inactive	First Health Life & Health Insurance Company	301735	Agent - Health	9/4/2012	5/31/2016
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	10/31/2012	4/14/2014
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	10/31/2012	4/14/2014
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	10/31/2012	4/14/2014
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	10/31/2012	4/14/2014
Inactive	Kanawha Insurance Company	300127	Agent - Health	10/31/2012	4/14/2014
Inactive	Kanawha Insurance Company	300127	Agent - Life	10/31/2012	4/14/2014
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	10/10/2012	3/8/2016
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	10/10/2012	3/8/2016
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	9/11/2015	3/8/2016
Inactive	West Bend Insurance Company	672974	Agent - Casualty	3/27/2015	5/31/2016
Inactive	West Bend Insurance Company	672974	Agent - Property	3/27/2015	5/31/2016

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 - Life	8/30/2012	5/31/2016
Inactive	Designated Agent Company Inc.	681257	Agent - Health	8/30/2012	5/31/2016
Inactive	Fundamental Insurance and Retirement Planning	675147	Agent - Life	8/30/2012	5/31/2016
Inactive	Fundamental Insurance and Retirement Planning	675147	Agent - Health	8/30/2012	5/31/2016