DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Mutual Med Insurance Services Southeast LLC	DOIID	1110230	NAIC NPN	19567194

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	4/12/2023		3/31/2026
Active	Non Resident	Agent	Life	11/12/2020		3/31/2026
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	01/15/2026	03/31/2026

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	All Savers Insurance Company	301940	Agent - Health	4/8/2024
Active	All Savers Insurance Company	301940	Agent - Life	4/8/2024
Active	UnitedHealthcare Insurance Company	300946	Agent - Health	6/12/2023
Active	UnitedHealthcare Insurance Company	300946	Agent - Life	12/7/2020
Active	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	6/12/2023
Active	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Life	12/7/2020
Active	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	6/12/2023
Active	UnitedHealthcare of Ohio, Inc.	300493	Agent - Life	12/7/2020

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Bender, Janson J	1105300	Agent - Health	11/12/2020	12/31/2022
Inactive	Bender, Janson J	1105300	Agent - Life	11/12/2020	12/31/2022
Active	Edel, Robert D	1127077	Agent - Health	4/12/2023
Active	Edel, Robert D	1127077	Agent - Life	3/14/2023
Denied	Johnston, Phyllis M	1109541	Agent - Health
Denied	Johnston, Phyllis M	1109541	Agent - Life