DEPARTMENT OF INSURANCE

Name	Self Funded Services Company	DOIID	654476	NAIC NPN	3197992

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date	Designated Home State
Inactive	Non Resident	Administrator	Not Applicable	6/13/2007	7/1/2010

*If a status is Pending, Pending Replacement,or the record displays Affidavit on File, click on them for more details.

No License Renewal Information

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date.

Address Information

Type	Address
Mailing	300 Security Building P.O. Box 389Dubuque, IA 52004
Business / Home Office	300 Security Building Dubuque, IA 52004

Phone Information

Type	Phone
Business / Home Office	(563) 587-7344