DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Fones, John Mark	DOIID	306203	NAIC NPN	7158409

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Administrator	Not Applicable	5/1/2000	9/30/2009
Inactive	Resident	Agent	Health	9/14/1993	9/30/2015
Inactive	Resident	Agent	Life	9/14/1993	1/16/2002
Inactive	Resident	Agent	Health Maintenance Organization	8/2/1995	3/1/2001
AFFIDAVIT ON FILE
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Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	CHA HMO, Inc.	300662	Agent - Health	3/1/2001	2/25/2003
Inactive	CHA HMO, Inc.	300662	Agent - Health Maintenance Organization	8/2/1995	3/1/2001
Inactive	Wilco Life Insurance Company	300122	Agent - Health	9/14/1993	4/27/2001
Inactive	Wilco Life Insurance Company	300122	Agent - Life	9/14/1993	4/27/2001

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Commonwealth Health Corporation	400683	Agent - Life	8/28/1998	1/16/2002
Inactive	Commonwealth Health Corporation	400683	Agent - Health	8/28/1998	2/25/2003
Inactive	Commonwealth Health Corporation	400683	Agent - Health Maintenance Organization	2/14/1997	3/1/2001
Inactive	Commonwealth Health Corporation	507058	Administrator - Not Applicable	5/1/2000	9/30/2009