Agency Information

EMPLOYEE BENEFIT SYSTEMS INC

10000 MEMORIAL DR STE 800

HOUSTON, TX 77024-3419

713-812-0900

licensing@ebsworksite.com

1931173

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res. Producer Firm	17513	01/20/2004	Active	01/20/2004	01/31/2028

Qualification Type	Original Issue Date	Status	Effective Date
Health	01/20/2004	Active	01/20/2004
Life	01/20/2004	Active	01/20/2004

Company Name	Appointment Type	Status	Active Date
17
ACE AMERICAN INSURANCE COMPANY	Health	Active	04/14/2022
6
Company Name	Appointment Type	Status	Active Date
ACE PROPERTY & CASUALTY INSURANCE COMPANY	Health	Active	04/14/2022
885
Company Name	Appointment Type	Status	Active Date
BOSTON MUTUAL LIFE INSURANCE COMPANY	Health	Active	02/19/2004
	Life	Active	02/19/2004
167
Company Name	Appointment Type	Status	Active Date
COMBINED INSURANCE COMPANY OF AMERICA	Health	Active	03/14/2024
	Life	Active	03/14/2024
174724
Company Name	Appointment Type	Status	Active Date
HEALTH NET OF ARIZONA, INC. DBA WELLCARE WELLCARE BY ALLWELL	Health	Active	10/18/2025
552
Company Name	Appointment Type	Status	Active Date
PROVIDENT LIFE & ACCIDENT INSURANCE COMPANY	Health	Active	03/21/2022
	Life	Active	03/21/2022
18304
Company Name	Appointment Type	Status	Active Date
STARMOUNT LIFE INSURANCE COMPANY	Health	Active	03/21/2022
654
Company Name	Appointment Type	Status	Active Date
UNITEDHEALTHCARE INSURANCE COMPANY	Health	Active	03/07/2025
517
Company Name	Appointment Type	Status	Active Date
UNUM INSURANCE COMPANY	Health	Active	03/21/2022
	Life	Active	03/21/2022
670
Company Name	Appointment Type	Status	Active Date
UNUM LIFE INSURANCE COMPANY OF AMERICA	Health	Active	03/21/2022
	Life	Active	03/21/2022
16894
Company Name	Appointment Type	Status	Active Date
WELLCARE PRESCRIPTION INSURANCE INC	Health	Active	10/18/2025

row(s) 1 - 16 of 16

Name	Association Type	Agent	Begin Date	End Date
JEFFREY CHRISTOPHER GRIM	Designated Resp Lic Prdcr	Yes	07/08/2021	-

1 - 1