DEPARTMENT OF INSURANCE

Affiliations

Name	Van Keuren, Robert Elliott	DOIID	349597	NAIC NPN	1497220

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Health Maintenance Organization	4/6/1998	3/1/2001
Inactive	Resident	Agent	Life	4/12/2017	11/30/2020
Inactive	Resident	Agent	Health	4/12/2017	11/30/2020
* 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	AF&L Insurance Company	301582	Agent - Health	6/18/2001	7/1/2006
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Health	3/9/2007	2/6/2010
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	3/9/2007	2/6/2010
Inactive	American Equity Investment Life Insurance Company	300389	Agent - Life	3/28/2007	8/20/2009
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	10/8/2004	7/1/2006
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	10/8/2004	7/1/2006
Inactive	American General Life Insurance Company	301585	Agent - Health	12/18/2019	11/30/2020
Inactive	American General Life Insurance Company	301585	Agent - Life	12/18/2019	11/30/2020
Inactive	American Republic Insurance Company	300861	Agent - Health	1/14/1998	12/5/2003
Inactive	American Republic Insurance Company	300861	Agent - Life	1/14/1998	12/5/2003
Inactive	American States Life Insurance Company	301884	Agent - Health	11/1/1998	11/26/2001
Inactive	American States Life Insurance Company	301884	Agent - Life	11/1/1998	11/26/2001
Inactive	Americo Financial Life and Annuity Insurance Company	300869	Agent - Health	4/9/2001	7/1/2006
Inactive	Americo Financial Life and Annuity Insurance Company	300869	Agent - Life	4/9/2001	7/1/2006
Inactive	Assurity Life Insurance Company	301099	Agent - Health	2/25/1999	12/19/2000
Inactive	Assurity Life Insurance Company	301099	Agent - Life	3/2/2011	7/9/2011
Inactive	Athene Annuity & Life Assurance Company	301798	Agent - Health	10/29/1997	10/5/1998
Inactive	Athene Annuity & Life Assurance Company	301798	Agent - Life	10/29/1997	10/5/1998
Inactive	Athene Annuity and Life Company	301893	Agent - Life	5/1/2015	11/11/2015
Inactive	Banner Life Insurance Company	301696	Agent - Life	12/3/2003	7/1/2006
Inactive	Combined Insurance Company of America	301472	Agent - Health	12/21/2012	11/30/2014
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	7/9/2010	11/30/2014
Inactive	Conseco Health Insurance Company	301725	Agent - Health	9/6/2000	5/28/2004
Inactive	Conseco Health Insurance Company	301725	Agent - Life	9/6/2000	5/28/2004
Inactive	Cotton States Life Insurance Company	300268	Agent - Life	4/16/2001	7/1/2006
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	3/21/2009	11/30/2014
Inactive	EquiTrust Life Insurance Company	502870	Agent - Life	5/4/2012	6/12/2014
Inactive	First Colony Life Insurance Company	301179	Agent - Health	8/13/2003	7/1/2006
Inactive	First Colony Life Insurance Company	301179	Agent - Life	8/13/2003	7/1/2006
Inactive	First Penn-Pacific Life Insurance Company	301581	Agent - Health	4/17/1998	7/1/2006
Inactive	First Penn-Pacific Life Insurance Company	301581	Agent - Life	4/17/1998	7/1/2006
Inactive	Genworth Life and Annuity Insurance Company	301276	Agent - Health	3/29/2012	12/7/2012
Inactive	Genworth Life and Annuity Insurance Company	301276	Agent - Life	3/29/2012	12/7/2012
Inactive	Gerber Life Insurance Company	300529	Agent - Health	10/11/2011	12/26/2012
Inactive	Gerber Life Insurance Company	300529	Agent - Life	10/11/2011	12/26/2012
Inactive	Golden Rule Insurance Company	301943	Agent - Health	8/29/1996	11/8/2004
Inactive	Golden Rule Insurance Company	301943	Agent - Life	8/29/1996	11/8/2004
Inactive	Government Personnel Mutual Life Insurance Company	301862	Agent - Health	7/10/2017	11/30/2020
Inactive	Government Personnel Mutual Life Insurance Company	301862	Agent - Life	7/10/2017	7/21/2020
Inactive	Great Southern Life Insurance Company	301443	Agent - Health	4/9/2001	6/7/2002
Inactive	Great Southern Life Insurance Company	301443	Agent - Life	4/9/2001	6/7/2002
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	3/26/2007	11/30/2014
Inactive	Humana Health Plan, Inc.	300142	Agent - Health Maintenance Organization	4/6/1998	3/1/2001
Inactive	Humana Insurance Company	301104	Agent - Health	3/26/2007	11/30/2014
Inactive	Humana Insurance Company	301104	Agent - Life	3/26/2007	11/30/2014
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	11/16/2011	11/30/2014
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	11/16/2011	11/30/2014
Inactive	HumanaDental Insurance Company	301457	Agent - Health	3/23/2012	12/19/2012
Inactive	HumanaDental Insurance Company	301457	Agent - Life	3/23/2012	12/19/2012
Inactive	Jefferson National Life Insurance Company	300258	Agent - Life	5/28/2004	6/8/2006
Inactive	Jefferson Pilot Financial Insurance Company	300756	Agent - Health	3/3/1998	7/1/2006
Inactive	Jefferson Pilot Financial Insurance Company	300756	Agent - Life	3/3/1998	7/1/2006
Inactive	Jefferson-Pilot Life Insurance Company	300379	Agent - Health	5/28/2003	7/1/2006
Inactive	Jefferson-Pilot Life Insurance Company	300379	Agent - Life	5/28/2003	7/1/2006
Inactive	Kanawha Insurance Company	300127	Agent - Health	6/7/2013	11/30/2014
Inactive	Kanawha Insurance Company	300127	Agent - Life	6/7/2013	11/30/2014
Inactive	Life Insurance Company of the Southwest	301867	Agent - Health	6/22/1998	7/1/2006
Inactive	Life Insurance Company of the Southwest	301867	Agent - Life	6/22/1998	7/1/2006
Inactive	Life Investors Insurance Company of America	301793	Agent - Health	4/17/2006	7/1/2006
Inactive	Life Investors Insurance Company of America	301793	Agent - Life	4/17/2006	7/1/2006
Inactive	LifeSecure Insurance Company	301629	Agent - Health	5/20/1999	7/23/2001
Inactive	LifeSecure Insurance Company	301629	Agent - Life	5/20/1999	7/23/2001
Inactive	LifeUSA Insurance Company	300386	Agent - Health	5/20/1996	8/2/2002
Inactive	LifeUSA Insurance Company	300386	Agent - Life	5/20/1996	8/2/2002
Inactive	Lincoln Benefit Life Company	301110	Agent - Health	8/6/1998	7/1/2006
Inactive	Lincoln Benefit Life Company	301110	Agent - Life	8/6/1998	7/1/2006
Inactive	Lincoln Heritage Life Insurance Company	500016	Agent - Health	12/29/2017	8/11/2018
Inactive	Lincoln Heritage Life Insurance Company	500016	Agent - Life	12/29/2017	8/11/2018
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Health	6/13/1996	4/14/2000
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Life	6/13/1996	4/14/2000
Inactive	Madison National Life Insurance Company Inc.	301458	Agent - Health	1/24/2011	10/27/2011
Inactive	Madison National Life Insurance Company Inc.	301458	Agent - Life	1/24/2011	10/27/2011
Inactive	Midland National Life Insurance Company	300923	Agent - Life	9/30/2002	10/5/2004
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	3/8/2012	6/24/2013
Inactive	National Western Life Insurance Company	301515	Agent - Life	1/20/2011	11/30/2014
Inactive	North American Company for Life and Health Insurance	300291	Agent - Life	4/12/2012	11/30/2014
Inactive	Northern Life Insurance Company	300301	Agent - Life	6/5/2002	10/2/2002
Inactive	Old Line Life Insurance Company of America (The)	301709	Agent - Health	1/14/1999	11/14/2001
Inactive	Old Line Life Insurance Company of America (The)	301709	Agent - Life	1/14/1999	11/14/2001
Inactive	Paul Revere Life Insurance Company	300971	Agent - Health	7/10/1998	8/24/2000
Inactive	Paul Revere Life Insurance Company	300971	Agent - Life	7/10/1998	8/24/2000
Inactive	Peoples Benefit Life Insurance Company	301895	Agent - Health	3/6/2007	8/7/2007
Inactive	Peoples Benefit Life Insurance Company	301895	Agent - Life	3/6/2007	8/7/2007
Inactive	Pioneer Life Insurance Company	300110	Agent - Health	4/5/1999	8/18/2003
Inactive	Pioneer Life Insurance Company	300110	Agent - Life	4/5/1999	8/18/2003
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	3/20/1997	8/24/2000
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	3/20/1997	8/24/2000
Inactive	ReliaStar Life Insurance Company	301712	Agent - Health	7/11/2008	11/30/2014
Inactive	ReliaStar Life Insurance Company	301712	Agent - Life	7/11/2008	11/30/2014
Inactive	Sagicor Life Insurance Company	300459	Agent - Health	2/26/2013	5/21/2013
Inactive	Sagicor Life Insurance Company	300459	Agent - Life	3/13/2013	12/19/2014
Inactive	Security Life of Denver Insurance Company	300648	Agent - Health	6/4/2010	9/29/2012
Inactive	Security Life of Denver Insurance Company	300648	Agent - Life	6/4/2010	9/29/2012
Inactive	Settlers Life Insurance Company	300189	Agent - Life	3/5/2001	3/20/2003
Inactive	Southland Life Insurance Company	301175	Agent - Health	4/24/1996	10/1/2004
Inactive	Southland Life Insurance Company	301175	Agent - Life	4/24/1996	10/1/2004
Inactive	Standard Life and Accident Insurance Company	301534	Agent - Health	7/2/2001	2/20/2006
Inactive	Standard Life and Accident Insurance Company	301534	Agent - Life	7/2/2001	2/20/2006
Inactive	State Mutual Insurance Company	300359	Agent - Health	2/12/2004	12/22/2005
Inactive	State Mutual Insurance Company	300359	Agent - Life	2/12/2004	12/22/2005
Inactive	Symetra Life Insurance Company	301691	Agent - Health	12/4/1997	12/28/2004
Inactive	Symetra Life Insurance Company	301691	Agent - Life	12/4/1997	12/28/2004
Inactive	Talcott Resolution Life and Annuity Insurance Company	300932	Agent - Health	6/14/2011	11/23/2012
Inactive	Talcott Resolution Life and Annuity Insurance Company	300932	Agent - Life	6/14/2011	11/23/2012
Inactive	Time Insurance Company	300683	Agent - Health	11/30/2007	10/17/2011
Inactive	Time Insurance Company	300683	Agent - Life	11/30/2007	10/17/2011
Inactive	Transamerica Life Insurance Company	300571	Agent - Health	6/8/2011	11/30/2014
Inactive	Transamerica Life Insurance Company	300571	Agent - Life	6/8/2011	11/30/2014
Inactive	Transamerica Life Insurance and Annuity Company	300148	Agent - Life	9/17/2004	10/1/2005
Inactive	Transamerica Occidental Life Insurance Company	300966	Agent - Health	9/17/2004	7/1/2006
Inactive	Transamerica Occidental Life Insurance Company	300966	Agent - Life	9/17/2004	7/1/2006
Inactive	Trustmark Insurance Company	300317	Agent - Health	11/12/2003	7/1/2006
Inactive	Trustmark Insurance Company	300317	Agent - Life	11/12/2003	7/1/2006
Inactive	U.S. Financial Life Insurance Company	301812	Agent - Health	12/2/1997	7/1/2006
Inactive	U.S. Financial Life Insurance Company	301812	Agent - Life	12/2/1997	7/1/2006
Inactive	USG Annuity & Life Company	300457	Agent - Life	7/31/2003	1/1/2004
Inactive	Union Security Insurance Company	301844	Agent - Health	3/18/2005	7/1/2006
Inactive	Union Security Insurance Company	301844	Agent - Life	3/18/2005	7/1/2006
Inactive	United American Insurance Company	300910	Agent - Health	1/4/2019	12/15/2020
Inactive	United American Insurance Company	300910	Agent - Life	1/4/2019	12/15/2020
Inactive	United Home Life Insurance Company	300421	Agent - Life	8/27/2010	11/15/2011
Inactive	United World Life Insurance Company	300532	Agent - Health	3/11/2005	7/1/2006
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	3/8/2012	6/24/2013
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	3/8/2012	6/24/2013
Inactive	Venerable Insurance and Annuity Company	301006	Agent - Life	1/1/2004	7/1/2006
Inactive	West Coast Life Insurance Company	301607	Agent - Life	10/7/2004	12/29/2005
Inactive	Wysh Life and Health Insurance Company	779030	Agent - Health	10/15/2012	11/30/2014

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Designated Agent Company Inc.	681257	Agent - Life	12/17/2013	11/30/2014
Inactive	Designated Agent Company Inc.	681257	Agent - Health	12/17/2013	11/30/2014
Inactive	Medlink Inc	400721	Agent - Life	7/10/2017	11/30/2020
Inactive	Medlink Inc	400721	Agent - Health	7/10/2017	11/30/2020
Inactive	Planchoice Inc.	400482	Agent - Life	3/5/2003	7/1/2006
Inactive	Planchoice Inc.	400482	Agent - Health	4/17/2014	11/30/2014