DEPARTMENT OF INSURANCE

Affiliations

Name	1 Sourceadmin LLC DBA : Connected Benefits	DOIID	853638	NAIC NPN	17168811

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Life	9/25/2014	3/31/2018
Inactive	Non Resident	Agent	Health	9/25/2014	3/31/2018
* 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	ALPHA Dental Programs, Inc.	635438	Agent - Health	9/4/2015	3/31/2018
Inactive	Anthem Life Insurance Company	301209	Agent - Health	12/17/2015	9/26/2016
Inactive	Anthem Life Insurance Company	301209	Agent - Life	12/17/2015	9/26/2016
Inactive	Combined Insurance Company of America	301472	Agent - Health	2/23/2016	3/31/2018
Inactive	Combined Insurance Company of America	301472	Agent - Life	2/23/2016	3/31/2018
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	3/24/2016	5/2/2016
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	3/24/2016	5/2/2016
Inactive	Guardian Life Insurance Company of America	301316	Agent - Health	10/27/2015	3/31/2018
Inactive	Guardian Life Insurance Company of America	301316	Agent - Life	10/27/2015	3/31/2018
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	5/10/2016	12/13/2016
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	5/10/2016	5/2/2017
Inactive	Humana Insurance Company	301104	Agent - Health	1/16/2017	3/13/2018
Inactive	Humana Insurance Company	301104	Agent - Life	1/16/2017	3/13/2018
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	5/10/2016	12/13/2016
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	12/14/2016	5/2/2017
Inactive	Kanawha Insurance Company	300127	Agent - Health	11/13/2014	10/22/2015
Inactive	Kanawha Insurance Company	300127	Agent - Life	11/13/2014	10/22/2015
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	11/7/2014	3/31/2018
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	11/7/2014	3/31/2018
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	11/7/2014	3/31/2018
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	11/7/2014	3/31/2018
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	6/1/2017	3/31/2018
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	6/1/2017	3/31/2018
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	10/20/2014	3/31/2018
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	10/20/2014	3/31/2018

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Gaydos, Robert	845158	Agent - Health	9/25/2014	3/31/2018
Inactive	Gaydos, Robert	845158	Agent - Life	9/25/2014	3/31/2018