DEPARTMENT OF INSURANCE

Affiliations

Name	Commonwealth Benefit Administrators Llc	DOIID	705133	NAIC NPN	13855907

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Administrator	Not Applicable	4/19/2011	7/21/2014
Inactive	Resident	Agent	Property	11/27/2012	7/21/2014
Inactive	Resident	Agent	Health	5/4/2009	7/21/2014
Inactive	Resident	Agent	Casualty	11/27/2012	7/21/2014
Inactive	Resident	Agent	Life	5/4/2009	7/21/2014
* 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
Inactive	Assurance Company of America	300432	Agent - Casualty	4/3/2013	1/20/2014
Inactive	Assurance Company of America	300432	Agent - Property	4/3/2013	1/20/2014
Inactive	Automobile Insurance Company of Hartford, Connecticut	300630	Agent - Casualty	2/19/2013	7/21/2014
Inactive	Automobile Insurance Company of Hartford, Connecticut	300630	Agent - Property	2/19/2013	7/21/2014
Inactive	Bristol West Insurance Company	301655	Agent - Casualty	7/17/2014	7/21/2014
Inactive	Bristol West Insurance Company	301655	Agent - Property	7/17/2014	7/21/2014
Inactive	CSAA Fire & Casualty Insurance Company	606666	Agent - Casualty	4/10/2013	7/21/2014
Inactive	CSAA Fire & Casualty Insurance Company	606666	Agent - Property	4/10/2013	7/21/2014
Inactive	CSAA General Insurance Company	606675	Agent - Casualty	4/10/2013	7/21/2014
Inactive	CSAA General Insurance Company	606675	Agent - Property	4/10/2013	7/21/2014
Inactive	Colonial Life and Accident Insurance Company	300846	Agent - Health	9/9/2013	7/21/2014
Inactive	Colonial Life and Accident Insurance Company	300846	Agent - Life	9/9/2013	7/21/2014
Inactive	Continental American Insurance Company	301700	Agent - Health	3/16/2011	7/21/2014
Inactive	Continental American Insurance Company	301700	Agent - Life	3/16/2011	7/21/2014
Inactive	Dental Care Plus Inc.	301495	Agent - Health	3/29/2013	7/21/2014
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Casualty	1/11/2013	7/21/2014
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Property	1/11/2013	7/21/2014
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Health	9/18/2013	7/21/2014
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Life	9/18/2013	7/21/2014
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	7/17/2014	7/21/2014
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	7/17/2014	7/21/2014
Inactive	Golden Rule Insurance Company	301943	Agent - Health	10/16/2013	7/21/2014
Inactive	Golden Rule Insurance Company	301943	Agent - Life	10/16/2013	7/21/2014
Inactive	Grange Indemnity Insurance Company	300793	Agent - Casualty	5/8/2014	7/21/2014
Inactive	Grange Indemnity Insurance Company	300793	Agent - Property	5/8/2014	7/21/2014
Inactive	Grange Insurance Company	300234	Agent - Casualty	5/8/2014	7/21/2014
Inactive	Grange Insurance Company	300234	Agent - Property	5/8/2014	7/21/2014
Inactive	Grange Life Insurance Company	300128	Agent - Health	5/8/2014	7/21/2014
Inactive	Grange Life Insurance Company	300128	Agent - Life	5/8/2014	7/21/2014
Inactive	Grange Property & Casualty Insurance Company	601680	Agent - Casualty	5/8/2014	7/21/2014
Inactive	Grange Property & Casualty Insurance Company	601680	Agent - Property	5/8/2014	7/21/2014
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	6/9/2009	7/21/2014
Inactive	Humana Insurance Company	301104	Agent - Health	6/9/2009	7/21/2014
Inactive	Humana Insurance Company	301104	Agent - Life	6/9/2009	7/21/2014
Inactive	HumanaDental Insurance Company	301457	Agent - Health	6/9/2009	2/23/2012
Inactive	HumanaDental Insurance Company	301457	Agent - Life	6/9/2009	2/23/2012
Inactive	Infinity Insurance Company	300416	Agent - Casualty	1/2/2014	7/21/2014
Inactive	Kanawha Insurance Company	300127	Agent - Health	6/9/2009	7/21/2014
Inactive	Kanawha Insurance Company	300127	Agent - Life	6/9/2009	7/21/2014
Inactive	Kentucky Health Cooperative, Inc.	798780	Agent - Health	1/15/2014	7/21/2014
Inactive	Maryland Casualty Company	301719	Agent - Casualty	4/3/2013	1/20/2014
Inactive	Maryland Casualty Company	301719	Agent - Property	4/3/2013	1/20/2014
Inactive	National General Assurance Company	301108	Agent - Casualty	1/28/2013	1/15/2014
Inactive	National General Insurance Company	300152	Agent - Casualty	1/14/2014	7/21/2014
Inactive	National General Insurance Company	300152	Agent - Property	1/14/2014	7/21/2014
Inactive	North American Company for Life and Health Insurance	300291	Agent - Life	11/26/2013	7/21/2014
Inactive	Northern Insurance Company of New York	301317	Agent - Casualty	4/3/2013	1/20/2014
Inactive	Northern Insurance Company of New York	301317	Agent - Property	4/3/2013	1/20/2014
Inactive	Progressive Casualty Insurance Company	300696	Agent - Casualty	11/30/2012	7/21/2014
Inactive	Progressive Casualty Insurance Company	300696	Agent - Property	11/30/2012	7/21/2014
Inactive	Pruco Life Insurance Company	300954	Agent - Life	1/13/2014	7/21/2014
Inactive	ReliaStar Life Insurance Company	301712	Agent - Health	11/15/2012	5/16/2014
Inactive	ReliaStar Life Insurance Company	301712	Agent - Life	11/15/2012	5/16/2014
Inactive	SAFECO Insurance Company of America	300159	Agent - Casualty	1/29/2013	7/21/2014
Inactive	SAFECO Insurance Company of America	300159	Agent - Property	1/29/2013	7/21/2014
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Casualty	1/29/2013	7/21/2014
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Property	1/29/2013	7/21/2014
Inactive	Standard Fire Insurance Company (The)	301068	Agent - Casualty	2/19/2013	7/21/2014
Inactive	Standard Fire Insurance Company (The)	301068	Agent - Property	2/19/2013	7/21/2014
Inactive	The Phoenix Insurance Company	301502	Agent - Casualty	2/19/2013	7/21/2014
Inactive	The Phoenix Insurance Company	301502	Agent - Property	2/19/2013	7/21/2014
Inactive	The Savings Bank Mutual Life Insurance Company of Massachusetts	690290	Agent - Life	8/27/2012	7/21/2014
Inactive	Titan Indemnity Company	300556	Agent - Casualty	11/29/2012	7/21/2014
Inactive	Titan Indemnity Company	300556	Agent - Property	11/29/2012	7/21/2014
Inactive	Transamerica Life Insurance Company	300571	Agent - Health	10/11/2013	7/21/2014
Inactive	Transamerica Life Insurance Company	300571	Agent - Life	10/11/2013	7/21/2014
Inactive	Travelers Commercial Insurance Company	301506	Agent - Casualty	2/19/2013	7/21/2014
Inactive	Travelers Commercial Insurance Company	301506	Agent - Property	2/19/2013	7/21/2014
Inactive	Travelers Home and Marine Insurance Company (The)	301802	Agent - Casualty	2/19/2013	7/21/2014
Inactive	Travelers Home and Marine Insurance Company (The)	301802	Agent - Property	2/19/2013	7/21/2014
Inactive	Travelers Indemnity Company (The)	301855	Agent - Casualty	2/19/2013	7/21/2014
Inactive	Travelers Indemnity Company (The)	301855	Agent - Property	2/19/2013	7/21/2014
Inactive	Travelers Indemnity Company of America (The)	301093	Agent - Casualty	2/19/2013	7/21/2014
Inactive	Travelers Indemnity Company of America (The)	301093	Agent - Property	2/19/2013	7/21/2014
Inactive	Trexis Insurance Corporation	599902	Agent - Casualty	12/5/2012	7/21/2014
Inactive	Trustgard Insurance Company	300104	Agent - Casualty	5/8/2014	7/21/2014
Inactive	Trustgard Insurance Company	300104	Agent - Property	5/8/2014	7/21/2014
Inactive	United Financial Casualty Company	301886	Agent - Casualty	11/30/2012	7/21/2014
Inactive	United Financial Casualty Company	301886	Agent - Property	11/30/2012	7/21/2014
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	11/27/2013	7/21/2014
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	11/27/2013	7/21/2014
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	11/27/2013	7/21/2014
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	11/27/2013	7/21/2014
Inactive	Victoria Fire & Casualty Company	300313	Agent - Casualty	11/29/2012	7/21/2014
Inactive	Victoria Fire & Casualty Company	300313	Agent - Property	11/29/2012	7/21/2014
Inactive	Washington National Insurance Company	300587	Agent - Health	7/13/2011	2/25/2014
Inactive	Washington National Insurance Company	300587	Agent - Life	7/13/2011	2/25/2014
Inactive	Western Surety Company	300283	Agent - Casualty	12/18/2013	7/21/2014

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Carrithers, Marion G	586679	Agent - Health	5/4/2009	5/16/2012
Inactive	Carrithers, Marion G	586679	Agent - Life	5/4/2009	5/16/2012
Inactive	Dragomir, Dale L	711197	Agent - Health	10/9/2013	7/21/2014
Inactive	Dragomir, Dale L	711197	Agent - Life	10/9/2013	7/21/2014
Inactive	Edwards, Shawna Paige	325016	Agent - Health	1/28/2014	7/21/2014
Inactive	Edwards, Shawna Paige	325016	Agent - Life	1/28/2014	7/21/2014
Inactive	Kimbrough, Kerry Delmar	509502	Agent - Health	3/11/2014	7/21/2014
Inactive	Kimbrough, Kerry Delmar	509502	Agent - Life	3/11/2014	7/21/2014
Inactive	King, Carla J	767160	Agent - Casualty	1/30/2013	7/21/2014
Inactive	King, Carla J	767160	Agent - Health	12/6/2012	7/21/2014
Inactive	King, Carla J	767160	Agent - Life	12/6/2012	7/21/2014
Inactive	King, Carla J	767160	Agent - Property	1/30/2013	7/21/2014
Inactive	Kuykendall, Joseph H	800465	Agent - Casualty	4/4/2014	7/21/2014
Inactive	Kuykendall, Joseph H	800465	Agent - Property	4/4/2014	7/21/2014
Inactive	Lawrence, Andrew D	305698	Agent - Casualty	6/12/2014	7/21/2014
Inactive	Lawrence, Andrew D	305698	Agent - Property	6/12/2014	7/21/2014
Inactive	Martinez, Angela Marie	665694	Agent - Health	10/22/2013	7/21/2014
Inactive	Martinez, Angela Marie	665694	Agent - Life	10/22/2013	7/21/2014
Inactive	Mercado, Kennith James	726712	Agent - Casualty	1/8/2014	7/21/2014
Inactive	Mercado, Kennith James	726712	Agent - Health	1/8/2014	7/21/2014
Inactive	Mercado, Kennith James	726712	Agent - Life	1/8/2014	7/21/2014
Inactive	Mercado, Kennith James	726712	Agent - Property	1/8/2014	7/21/2014
Inactive	Richie, Mary Michelle	633770	Agent - Casualty	4/19/2013	3/11/2014
Inactive	Richie, Mary Michelle	633770	Agent - Property	4/19/2013	3/11/2014
Inactive	Wilson, Chuck Andrew	580870	Agent - Health	5/4/2009	7/21/2014
Inactive	Wilson, Chuck Andrew	580870	Agent - Life	5/4/2009	7/21/2014
Inactive	Workman, Thomas Leeland	513266	Administrator - Not Applicable	4/19/2011	7/21/2014
Inactive	Workman, Thomas Leeland	513266	Agent - Casualty	11/27/2012	7/21/2014
Inactive	Workman, Thomas Leeland	513266	Agent - Health	5/4/2009	7/21/2014
Inactive	Workman, Thomas Leeland	513266	Agent - Life	5/4/2009	7/21/2014
Inactive	Workman, Thomas Leeland	513266	Agent - Property	11/27/2012	7/21/2014