DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Tiller, Sam	DOIID	1290197	NAIC NPN	20809174

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Casualty	8/25/2023		9/30/2025
Active	Resident	Agent	Life	8/22/2023		9/30/2025
Active	Resident	Agent	Property	8/25/2023		9/30/2025
Active	Resident	Agent	Health	8/22/2023		9/30/2025
* 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	07/15/2025	09/30/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	American Modern Home Insurance Company	300791	Agent - Casualty	9/21/2023
Active	American Modern Home Insurance Company	300791	Agent - Property	9/21/2023
Active	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	10/23/2023
Inactive	Anthem Health Plans of New Hampshire, Inc.	944064	Agent - Health	10/25/2023	12/19/2024
Active	Anthem Insurance Companies, Inc.	300941	Agent - Health	10/25/2023
Inactive	Bristol West Insurance Company	301655	Agent - Casualty	10/9/2023	12/20/2024
Inactive	Bristol West Insurance Company	301655	Agent - Property	10/9/2023	12/20/2024
Active	Compcare Health Services Insurance Corporation	948751	Agent - Health	10/25/2023
Active	Dairyland Insurance Company	301370	Agent - Casualty	2/5/2024
Active	Dairyland Insurance Company	301370	Agent - Property	2/5/2024
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	10/9/2023
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	10/9/2023
Active	Kentucky Farm Bureau Mutual Insurance Company	300570	Agent - Casualty	9/1/2023
Active	Kentucky Farm Bureau Mutual Insurance Company	300570	Agent - Health	9/1/2023
Active	Kentucky Farm Bureau Mutual Insurance Company	300570	Agent - Property	9/1/2023
Active	Southern Farm Bureau Life Insurance Company	300909	Agent - Health	9/1/2023
Active	Southern Farm Bureau Life Insurance Company	300909	Agent - Life	9/1/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Kentucky Farm Bureau Insurance Agency LLC	399619	Agent - Casualty	9/1/2023
Active	Kentucky Farm Bureau Insurance Agency LLC	399619	Agent - Life	9/1/2023
Active	Kentucky Farm Bureau Insurance Agency LLC	399619	Agent - Health	9/1/2023
Active	Kentucky Farm Bureau Insurance Agency LLC	399619	Agent - Property	9/1/2023