DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Hollis, Worthen David	DOIID	890075	NAIC NPN	17670498

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Life	9/8/2015		9/30/2024
Active	Non Resident	Agent	Health	9/8/2015		9/30/2024
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	07/15/2024	09/30/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Arcadian Health Plan, Inc.	728196	Agent - Health	10/11/2017
Active	CHA HMO, Inc.	300662	Agent - Health	12/20/2023
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	9/10/2015	12/23/2015
Active	CompBenefits Insurance Company	301864	Agent - Health	11/13/2019
Active	Dental Concern Inc. (The)	301641	Agent - Health	7/29/2016
Active	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	7/29/2016
Active	Humana Health Plan of Ohio Inc.	301565	Agent - Health	10/22/2018
Active	Humana Health Plan, Inc.	300142	Agent - Health	7/29/2016
Active	Humana Insurance Company	301104	Agent - Health	7/29/2016
Active	Humana Insurance Company	301104	Agent - Life	7/29/2016
Active	Humana Insurance Company of Kentucky	300826	Agent - Health	7/29/2016
Active	Humana Insurance Company of Kentucky	300826	Agent - Life	7/29/2016
Active	Humana Medical Plan, Inc.	801568	Agent - Health	7/29/2016
Active	Humana Wisconsin Health Organization Insurance Corporation	830687	Agent - Health	10/12/2016
Inactive	Kanawha Insurance Company	300127	Agent - Health	9/10/2015	10/22/2015
Inactive	Kanawha Insurance Company	300127	Agent - Life	9/10/2015	10/22/2015

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Humana MarketPOINT Inc.	398092	Agent - Life	8/16/2016
Active	Humana MarketPOINT Inc.	398092	Agent - Health	8/16/2016