DEPARTMENT OF INSURANCE

Affiliations

Name	Virgil Insurance Agency LLC DBA : Fair Square Medicare	DOIID	1119520	NAIC NPN	19464737

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Health	2/4/2021	3/31/2027
Active	Non Resident	Agent	Life	2/4/2021	3/31/2027
* 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	01/15/2025	03/31/2025	03/06/2025	03/06/2025	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Accendo Insurance Company	300312	Agent - Health	9/10/2021	11/17/2023
Active	Accendo Insurance Company	300312	Agent - Life	3/24/2021
Active	Aetna Health Inc. (PA)	660717	Agent - Health	2/11/2021
Active	Aetna Health and Life Insurance Company	300523	Agent - Health	3/24/2021
Active	Aetna Health of Ohio Inc.	1065035	Agent - Health	2/11/2021
Active	Aetna Life Insurance Company	301140	Agent - Health	2/11/2021
Inactive	American Continental Insurance Company	643130	Agent - Life	3/24/2021	8/11/2021
Active	Ameritas Life Insurance Corporation	300126	Agent - Health	1/5/2025
Active	Arcadian Health Plan, Inc.	728196	Agent - Health	1/3/2022
Active	Care Improvement Plus South Central Insurance Company	799697	Agent - Health	7/20/2022
Inactive	Cigna National Health Insurance Company	300235	Agent - Health	11/15/2023	12/26/2024
Inactive	Clear Spring Health Insurance Company	301686	Agent - Health	10/12/2022	12/19/2024
Active	CompBenefits Insurance Company	301864	Agent - Health	1/4/2022
Active	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	3/24/2021
Active	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Life	3/24/2021
Active	Devoted Health Insurance Company of Kentucky, Inc.	1306593	Agent - Health	10/11/2024
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	8/10/2021	12/12/2024
Active	Humana Health Plan of Ohio Inc.	301565	Agent - Health	2/1/2022
Active	Humana Health Plan, Inc.	300142	Agent - Health	6/4/2024
Active	Humana Insurance Company	301104	Agent - Health	12/6/2021
Active	Humana Medical Plan, Inc.	801568	Agent - Health	11/18/2021
Active	Medco Containment Life Insurance Company	301557	Agent - Health	6/10/2024
Active	Nassau Life Insurance Company of Kansas	300667	Agent - Health	11/23/2022
Active	National Health Insurance Company	300554	Agent - Health	7/24/2024
Active	National Health Insurance Company	300554	Agent - Life	7/24/2024
Active	SilverScript Insurance Company	663526	Agent - Health	2/11/2021
Active	Tier One Insurance Company	301056	Agent - Health	5/30/2023
Active	Tier One Insurance Company	301056	Agent - Life	5/30/2023
Active	UnitedHealthcare Insurance Company	300946	Agent - Health	2/11/2021
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	2/11/2021	12/22/2022
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	2/11/2021	12/23/2021
Active	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	2/11/2021
Active	WellCare Health Insurance Company of Kentucky, Inc.	301478	Agent - Health	2/3/2022
Active	WellCare Prescription Insurance Inc.	654329	Agent - Health	2/3/2022

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Austin, Peter W	1016264	Agent - Health	9/13/2023
Active	Austin, Peter W	1016264	Agent - Life	9/13/2023
Active	Bortolotti, Laurie Jean	1192483	Agent - Health	9/13/2023
Active	Bortolotti, Laurie Jean	1192483	Agent - Life	9/13/2023
Active	Bowman, Steven Joseph	1090571	Agent - Health	9/13/2023
Active	Bresky, Waine	1243370	Agent - Health	9/13/2023
Active	Bryant, Christopher	1051248	Agent - Health	9/13/2023
Active	Carlson, Leif Daniel	883632	Agent - Health	9/13/2023
Active	Casamassima, Joseph Anthony	1096442	Agent - Health	9/13/2023
Active	Casamassima, Joseph Anthony	1096442	Agent - Life	9/13/2023
Active	Cole, Scott Robert	1192683	Agent - Health	9/13/2023
Active	Cole, Scott Robert	1192683	Agent - Life	9/13/2023
Active	Hyder, Theresa Lynn	1005905	Agent - Health	9/13/2023
Active	Hyder, Theresa Lynn	1005905	Agent - Life	9/13/2023
Active	Kunst, Thomas Christopher	1226504	Agent - Health	9/13/2023
Active	Lee, Stephen	854187	Agent - Health	9/13/2023
Active	Petkevich, Daniel	976001	Agent - Health	2/4/2021
Active	Petkevich, Daniel	976001	Agent - Life	2/4/2021
Active	Tamayo, Peter Leija	1215563	Agent - Health	9/13/2023
Active	Tamayo, Peter Leija	1215563	Agent - Life	9/13/2023
Active	Watters, Larry Lateef	963012	Agent - Health	9/13/2023
Active	Watters, Larry Lateef	963012	Agent - Life	9/13/2023
Active	Wisdahl, Mindy Miller	1185882	Agent - Health	9/13/2023
Inactive	Wisdahl, Mindy Miller	1185882	Agent - Life	9/13/2023	5/10/2024