DEPARTMENT OF INSURANCE

Affiliations

Name	Guibotsy Mboulas, Marcel Leonce	DOIID	792896	NAIC NPN	16791665

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Life	9/28/2012	10/31/2015
Inactive	Non Resident	Agent	Health	9/28/2012	10/31/2015
* 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	8/18/2014	10/31/2015
Inactive	Aetna Health Insurance Company	301583	Agent - Health	8/18/2014	10/31/2015
Inactive	Aetna Life Insurance Company	301140	Agent - Health	8/18/2014	10/31/2015
Inactive	Aetna Life Insurance Company	301140	Agent - Life	8/18/2014	10/31/2015
Inactive	Anthem Life Insurance Company	301209	Agent - Health	8/5/2014	10/31/2015
Inactive	Anthem Life Insurance Company	301209	Agent - Life	8/5/2014	10/31/2015
Inactive	CIGNA Health & Life Insurance Company	301783	Agent - Health	8/27/2014	10/31/2015
Inactive	CIGNA Health & Life Insurance Company	301783	Agent - Life	8/27/2014	10/31/2015
Inactive	Coventry Health and Life Insurance Company	301771	Agent - Health	9/13/2014	10/31/2015
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	2/5/2014	8/6/2014
Inactive	First Health Life & Health Insurance Company	301735	Agent - Health	8/18/2014	10/31/2015
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	10/13/2014	10/31/2015
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	2/5/2014	8/6/2014
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	2/5/2014	8/6/2014
Inactive	Humana Insurance Company	301104	Agent - Health	10/31/2014	10/31/2015
Inactive	Humana Insurance Company	301104	Agent - Life	2/5/2014	8/6/2014
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	2/5/2014	8/6/2014
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	2/5/2014	8/6/2014
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	10/13/2014	10/31/2015
Inactive	Kanawha Insurance Company	300127	Agent - Health	2/5/2014	8/6/2014
Inactive	Kanawha Insurance Company	300127	Agent - Life	2/5/2014	8/6/2014
Inactive	Loyal American Life Insurance Company	301172	Agent - Health	8/28/2014	7/10/2015
Inactive	Loyal American Life Insurance Company	301172	Agent - Life	8/28/2014	7/10/2015
Inactive	Medco Containment Life Insurance Company	301557	Agent - Health	9/23/2014	10/31/2015
Inactive	SilverScript Insurance Company	663526	Agent - Health	8/28/2014	10/31/2015
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	8/25/2014	8/10/2015
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	8/25/2014	8/10/2015

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	8/5/2014	9/2/2015
Inactive	Designated Agent Company Inc.	681257	Agent - Health	8/5/2014	9/2/2015
Inactive	Extend Insurance Services, LLC	625753	Agent - Life	11/13/2014	10/31/2015
Inactive	Extend Insurance Services, LLC	625753	Agent - Health	11/13/2014	10/31/2015