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	3/31/2025
Active	Non Resident	Agent	Life	2/4/2021	3/31/2025
* 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	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	Arcadian Health Plan, Inc.	728196	Agent - Health	1/3/2022
Active	Care Improvement Plus South Central Insurance Company	799697	Agent - Health	7/20/2022
Active	Cigna National Health Insurance Company	300235	Agent - Health	11/15/2023
Active	Clear Spring Health Insurance Company	301686	Agent - Health	10/12/2022
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	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	8/10/2021
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	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