DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

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		3/31/2027
Active	Non Resident	Agent	Life	5/24/2017		3/31/2027
* 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
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
Active	Waren, Marshall H	1336632	Agent - Health	12/5/2024
Active	Waren, Marshall H	1336632	Agent - Life	12/5/2024