DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Ebenconcepts Co	DOIID	955223	NAIC NPN	7114373

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	5/24/2017		3/31/2025
Active	Non Resident	Agent	Life	5/24/2017		3/31/2025
* 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	01/15/2025	03/31/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Accendo Insurance Company	300312	Agent - Life	5/9/2024
Active	Aetna Health Inc. (PA)	660717	Agent - Health	10/2/2019
Active	Aetna Health of Ohio Inc.	1065035	Agent - Health	8/10/2020
Active	Aetna Life Insurance Company	301140	Agent - Health	10/2/2019
Active	Colonial Life and Accident Insurance Company	300846	Agent - Health	10/20/2023
Active	Colonial Life and Accident Insurance Company	300846	Agent - Life	10/20/2023
Active	Fidelity Security Life Insurance Company	300466	Agent - Health	6/7/2017
Active	Fidelity Security Life Insurance Company	300466	Agent - Life	6/7/2017
Active	Provident Life and Accident Insurance Company	301525	Agent - Health	12/17/2018
Active	Provident Life and Accident Insurance Company	301525	Agent - Life	12/17/2018
Active	SilverScript Insurance Company	663526	Agent - Health	10/1/2019
Active	Starmount Life Insurance Company	628031	Agent - Health	12/17/2018
Active	UNUM Life Insurance Company of America	300817	Agent - Health	12/17/2018
Active	UNUM Life Insurance Company of America	300817	Agent - Life	12/17/2018
Active	Unum Insurance Company	301499	Agent - Health	12/17/2018
Active	Unum Insurance Company	301499	Agent - Life	12/17/2018
Active	WellCare Health Insurance Company of Kentucky, Inc.	301478	Agent - Health	12/16/2023
Active	WellCare Prescription Insurance Inc.	654329	Agent - Health	12/16/2023

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Bass, Mouzon	741424	Agent - Health	6/1/2020	2/16/2024
Inactive	Bass, Mouzon	741424	Agent - Life	6/1/2020	2/16/2024
Active	Greenbaum, John Barton	858839	Agent - Health	2/16/2024
Active	Greenbaum, John Barton	858839	Agent - Life	2/16/2024
Inactive	Harrison, Christopher S	533248	Agent - Health	5/24/2017	6/1/2020
Inactive	Harrison, Christopher S	533248	Agent - Life	5/24/2017	6/1/2020