DEPARTMENT OF INSURANCE

Affiliations

Name	Hazelbaker, Richard Keith	DOIID	384277	NAIC NPN	55108

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Health	1/22/1993		6/30/2026
Active	Resident	Agent	Life	1/22/1993		6/30/2026
Inactive	Non Resident	Agent	Prepaid Dental Plan	6/22/1998	1/24/2000
* 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	8/3/2000	12/1/2006
Inactive	Accordia Life and Annuity Company	502966	Agent - Life	8/26/2018	4/20/2020
Active	Aetna Health and Life Insurance Company	300523	Agent - Health	6/2/2017
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Health	9/9/2005	12/27/2013
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	9/9/2005	12/27/2013
Inactive	American Continental Insurance Company	643130	Agent - Health	5/6/2011	2/17/2014
Inactive	American Continental Insurance Company	643130	Agent - Life	6/2/2017	8/11/2021
Active	American Equity Investment Life Insurance Company	300389	Agent - Life	8/2/2022
Active	American General Life Insurance Company	301585	Agent - Health	4/8/2022
Active	American General Life Insurance Company	301585	Agent - Life	4/8/2022
Inactive	American Investors Life Insurance Company, Inc.	301358	Agent - Life	10/3/2008	9/30/2009
Inactive	Americo Financial Life and Annuity Insurance Company	300869	Agent - Health	3/4/2011	8/27/2013
Inactive	Americo Financial Life and Annuity Insurance Company	300869	Agent - Life	3/4/2011	8/27/2013
Active	Aspida Life Insurance Company	301934	Agent - Life	8/13/2024
Inactive	Athene Annuity & Life Assurance Company	301798	Agent - Life	1/8/2012	8/10/2015
Inactive	Athene Annuity and Life Company	301893	Agent - Life	9/1/2021	6/9/2023
Active	Atlantic Coast Life Insurance Company	642114	Agent - Life	3/1/2023
Active	Augustar Life Insurance Company	301816	Agent - Life	9/20/2023
Inactive	Baltimore Life Insurance Company	300286	Agent - Health	12/14/2001	9/25/2003
Inactive	Baltimore Life Insurance Company	300286	Agent - Life	12/14/2001	9/25/2003
Inactive	Bankers Fidelity Assurance Company	554627	Agent - Health	5/17/2017	11/12/2020
Inactive	Bankers Fidelity Assurance Company	554627	Agent - Life	5/17/2017	11/12/2020
Inactive	Bankers Fidelity Life Insurance Company	300193	Agent - Health	5/17/2017	11/12/2020
Inactive	Bankers Fidelity Life Insurance Company	300193	Agent - Life	5/17/2017	11/12/2020
Active	Clear Spring Life and Annuity Company	300919	Agent - Life	8/28/2023
Inactive	Continental Casualty Company	301019	Agent - Health	7/1/2002	11/29/2004
Active	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	5/6/2011
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Life	5/6/2011	4/26/2016
Inactive	Dental Plan Managers Inc.	300547	Agent - Prepaid Dental Plan	6/22/1998	1/24/2000
Active	EquiTrust Life Insurance Company	502870	Agent - Life	10/3/2024
Inactive	Essence Healthcare, Inc.	657425	Agent - Health	12/17/2008	3/31/2011
Active	Fidelity & Guaranty Life Insurance Company	301359	Agent - Life	1/2/2014
Inactive	Genworth Life Insurance Company	300623	Agent - Health	12/17/2009	1/7/2014
Inactive	Genworth Life Insurance Company	300623	Agent - Life	12/17/2009	1/7/2014
Inactive	Gerber Life Insurance Company	300529	Agent - Health	7/6/2017	12/14/2020
Inactive	Gerber Life Insurance Company	300529	Agent - Life	7/6/2017	12/14/2020
Inactive	Guaranty Income Life Insurance Company	552451	Agent - Health	7/16/2014	7/1/2019
Inactive	Guaranty Income Life Insurance Company	552451	Agent - Life	7/16/2014	7/1/2019
Inactive	Indianapolis Life Insurance Company	301381	Agent - Life	7/11/2008	10/1/2008
Inactive	Investors Life Insurance Company of North America	301660	Agent - Life	8/7/2007	3/1/2008
Inactive	John Hancock Life Insurance Company	300821	Agent - Health	6/26/2003	12/30/2009
Inactive	John Hancock Life Insurance Company	300821	Agent - Life	6/26/2003	12/30/2009
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Health	9/19/2008	4/2/2013
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Life	9/19/2008	4/2/2013
Active	Liberty Bankers Life Insurance Company	542461	Agent - Life	7/24/2024
Inactive	Life Investors Insurance Company of America	301793	Agent - Health	1/22/1993	3/26/2003
Inactive	Life Investors Insurance Company of America	301793	Agent - Life	1/22/1993	3/26/2003
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Health	8/21/2009	9/28/2021
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Life	8/21/2009	9/28/2021
Inactive	MassMutual Ascend Life Insurance Company	300320	Agent - Life	9/20/2017	12/10/2022
Inactive	Medico Insurance Company	301559	Agent - Health	9/22/2021	12/21/2022
Inactive	Medico Insurance Company	301559	Agent - Life	9/22/2021	12/21/2022
Inactive	Medico Life and Health Insurance Company	907406	Agent - Health	1/3/2019	12/28/2020
Inactive	Medico Life and Health Insurance Company	907406	Agent - Life	1/3/2019	12/28/2020
Inactive	Minnesota Life Insurance Company	300488	Agent - Health	10/21/2014	3/7/2018
Inactive	Minnesota Life Insurance Company	300488	Agent - Life	10/21/2014	3/7/2018
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	3/10/2008	10/22/2014
Active	Nassau Life and Annuity Company	513671	Agent - Life	3/4/2024
Inactive	National Western Life Insurance Company	301515	Agent - Health	7/27/2005	2/14/2007
Inactive	National Western Life Insurance Company	301515	Agent - Life	10/16/2012	8/9/2017
Inactive	Nationwide Life and Annuity Insurance Company	300714	Agent - Health	12/27/2016	12/10/2018
Inactive	Nationwide Life and Annuity Insurance Company	300714	Agent - Life	12/27/2016	12/10/2018
Inactive	North American Company for Life and Health Insurance	300291	Agent - Life	11/28/2010	4/23/2019
Active	Oceanview Life and Annuity Company	301868	Agent - Life	8/13/2020
Inactive	Penn Treaty Network America Insurance Company	301297	Agent - Health	4/23/2007	11/27/2008
Inactive	Penn Treaty Network America Insurance Company	301297	Agent - Life	4/23/2007	11/27/2008
Inactive	Protective Life Insurance Company	300638	Agent - Health	4/23/2015	11/23/2017
Inactive	Protective Life Insurance Company	300638	Agent - Life	4/23/2015	11/23/2017
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	4/11/2003	11/10/2004
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	4/11/2003	11/10/2004
Inactive	Pruco Life Insurance Company	300954	Agent - Health	12/3/2010	12/23/2014
Inactive	Pruco Life Insurance Company	300954	Agent - Life	12/3/2010	12/23/2014
Inactive	Prudential Insurance Company of America	300784	Agent - Health	4/4/2007	12/23/2014
Inactive	Prudential Insurance Company of America	300784	Agent - Life	4/4/2007	12/23/2014
Active	Reliance Standard Life Insurance Company	300584	Agent - Life	5/20/2017
Inactive	SILAC Insurance Company	300535	Agent - Health	4/29/2009	12/8/2010
Active	SILAC Insurance Company	300535	Agent - Life	11/12/2019
Inactive	Sagicor Life Insurance Company	300459	Agent - Life	6/19/2018	3/8/2023
Inactive	Security Life of Denver Insurance Company	300648	Agent - Health	10/15/2014	2/27/2016
Inactive	Security Life of Denver Insurance Company	300648	Agent - Life	10/15/2014	2/27/2016
Inactive	Senior Health Insurance Company of Pennsylvania	300251	Agent - Health	4/20/1993	9/17/2003
Inactive	Senior Health Insurance Company of Pennsylvania	300251	Agent - Life	4/20/1993	9/17/2003
Active	Sentinel Security Life Insurance Company	935789	Agent - Life	8/1/2022
Inactive	Standard Insurance Company	300185	Agent - Health	7/12/2017	12/5/2022
Inactive	Standard Insurance Company	300185	Agent - Life	7/12/2017	12/5/2022
Inactive	State Life Insurance Company	301497	Agent - Health	5/3/2017	12/4/2023
Inactive	State Life Insurance Company	301497	Agent - Life	5/3/2017	12/4/2023
Inactive	Talcott Resolution Life and Annuity Insurance Company	300932	Agent - Health	8/15/2006	12/11/2009
Inactive	Talcott Resolution Life and Annuity Insurance Company	300932	Agent - Life	8/15/2006	12/11/2009
Inactive	Transamerica Life Insurance Company	300571	Agent - Health	8/13/2019	8/28/2019
Inactive	Transamerica Life Insurance Company	300571	Agent - Life	8/13/2019	8/28/2019
Inactive	U.S. Financial Life Insurance Company	301812	Agent - Life	9/14/2004	9/27/2007
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	4/11/2003	11/10/2004
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	4/11/2003	11/10/2004
Inactive	United Home Life Insurance Company	300421	Agent - Life	1/20/2013	11/26/2014
Inactive	United World Life Insurance Company	300532	Agent - Health	3/10/2008	12/15/2010
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	7/26/2013	6/23/2014
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	7/26/2013	6/23/2014
Inactive	Venerable Insurance and Annuity Company	301006	Agent - Life	9/8/2005	12/5/2015
Inactive	West Coast Life Insurance Company	301607	Agent - Health	2/17/2010	9/18/2012
Inactive	West Coast Life Insurance Company	301607	Agent - Life	2/17/2010	9/18/2012
Inactive		300277	Agent - Life	8/13/2004	1/1/2007

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	12/16/2013	2/10/2025
Inactive	Designated Agent Company Inc.	681257	Agent - Health	12/16/2013	2/10/2025
Inactive	Fundamental Insurance and Retirement Planning	675147	Agent - Life	10/10/2011	3/31/2018
Inactive	Fundamental Insurance and Retirement Planning	675147	Agent - Health	10/10/2011	3/31/2018
Active	North American Life Plans LLC	645076	Agent - Life	9/22/2010
Active	North American Life Plans LLC	645076	Agent - Health	9/22/2010
Active	R. Keith Hazelbaker Enterprises	610026	Agent - Life	6/23/2023
Active	R. Keith Hazelbaker Enterprises	610026	Agent - Health	6/23/2023