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DEPARTMENT OF INSURANCE
Affiliations
Name
Commonwealth Administrators, LLC
DBA : Fiserv Health-Commonwealth Administrators
DOIID
397899
NAIC NPN
4402548
License - Line of Authority Information
Status
Residency
Class
Line of Authority
Active Date
Inactive Date
License Expiration Date
Inactive
Resident
Administrator
Not Applicable
9/2/1999
3/19/2015
Inactive
Resident
Agent
Life
12/31/1999
5/14/2015
Inactive
Resident
Agent
Health
12/31/1999
5/14/2015
* 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
ACE American Insurance Company
300625
Agent - Health
4/10/2003
2/26/2007
Inactive
American General Life Insurance Company
301585
Agent - Health
12/31/2012
5/14/2015
Inactive
American General Life Insurance Company
301585
Agent - Life
12/31/2012
5/14/2015
Inactive
American General Life Insurance Company of Delaware
301057
Agent - Health
6/4/2001
12/31/2012
Inactive
American General Life Insurance Company of Delaware
301057
Agent - Life
6/4/2001
12/31/2012
Inactive
American Guarantee and Liability Insurance Company
301216
Agent - Health
11/14/2006
5/14/2015
Inactive
American United Life Insurance Company
300498
Agent - Health
6/8/2004
5/14/2015
Inactive
American United Life Insurance Company
300498
Agent - Life
6/8/2004
5/14/2015
Inactive
American Zurich Insurance Company
300592
Agent - Health
11/14/2006
5/14/2015
Inactive
Avemco Insurance Company
300669
Agent - Health
5/29/2001
2/28/2006
Inactive
Baltimore Life Insurance Company
300286
Agent - Health
10/30/2002
11/18/2004
Inactive
Baltimore Life Insurance Company
300286
Agent - Life
10/30/2002
11/18/2004
Inactive
Canada Life Reinsurance Company
301491
Agent - Health
8/15/2000
1/15/2002
Inactive
Delaware Life Insurance Company
301256
Agent - Life
12/31/2003
12/14/2012
Inactive
Fort Wayne Health & Casualty Insurance Company
301572
Agent - Health
2/8/2000
12/22/2004
Inactive
HCC Life Insurance Company
301827
Agent - Health
2/28/2006
9/11/2007
Inactive
HCC Life Insurance Company
301827
Agent - Life
2/28/2006
9/11/2007
Inactive
Hartford Life Group Insurance Company
301708
Agent - Health
12/21/2005
12/31/2006
Inactive
Hartford Life Group Insurance Company
301708
Agent - Life
12/21/2005
12/31/2006
Inactive
Hartford Life and Accident Insurance Company
300878
Agent - Health
12/5/2005
5/14/2015
Inactive
Hartford Life and Accident Insurance Company
300878
Agent - Life
12/5/2005
5/14/2015
Inactive
Keyport Life Insurance Company
300319
Agent - Life
12/15/2000
12/31/2003
Inactive
Lafayette Life Insurance Company (The)
301039
Agent - Health
5/19/2004
1/23/2008
Inactive
Lafayette Life Insurance Company (The)
301039
Agent - Life
5/19/2004
1/23/2008
Inactive
Legion Insurance Company
301490
Agent - Health
1/22/2002
7/1/2003
Inactive
Lincoln National Life Insurance Company (The)
301382
Agent - Health
2/8/2000
3/12/2002
Inactive
Lincoln National Life Insurance Company (The)
301382
Agent - Life
2/8/2000
3/8/2002
Inactive
Lincoln National Reassurance Company
301919
Agent - Health
2/8/2000
1/6/2003
Inactive
Lincoln National Reassurance Company
301919
Agent - Life
2/8/2000
1/6/2003
Inactive
Pacific Life & Annuity Company
300443
Agent - Health
6/19/2001
5/4/2006
Inactive
Pacific Life & Annuity Company
300443
Agent - Life
6/19/2001
5/4/2006
Inactive
Pacific Life Insurance Company
301848
Agent - Health
6/19/2001
5/14/2015
Inactive
Pacific Life Insurance Company
301848
Agent - Life
6/19/2001
5/14/2015
Inactive
Swiss Re Life & Health America, Inc.
300722
Agent - Health
1/6/2003
12/22/2004
Inactive
Swiss Re Life & Health America, Inc.
300722
Agent - Life
1/6/2003
12/22/2004
Inactive
Symetra Life Insurance Company
301691
Agent - Health
10/30/2002
5/14/2015
Inactive
Symetra Life Insurance Company
301691
Agent - Life
10/30/2002
5/14/2015
Inactive
TIG Insurance Company
301750
Agent - Health
2/5/2001
12/11/2001
Inactive
Union Labor Life Insurance Company
301832
Agent - Health
2/16/2001
7/15/2008
Inactive
Union Labor Life Insurance Company
301832
Agent - Life
2/16/2001
7/15/2008
Inactive
Union Security Insurance Company
301844
Agent - Health
12/31/1999
3/1/2004
Inactive
Union Security Insurance Company
301844
Agent - Life
12/31/1999
3/1/2004
Inactive
Zurich American Insurance Company
301121
Agent - Health
11/14/2006
5/14/2015
Inactive
Zurich American Insurance Company of Illinois
301805
Agent - Health
11/14/2006
5/14/2015
Designated Individuals
Status
Affiliation Name
DOI Number
Line of Authority
Active Date
Inactive Date
Inactive
Aldridge, Stephanie Renee
525523
Agent - Health
1/5/2004
3/1/2015
Inactive
Aldridge, Stephanie Renee
525523
Agent - Life
1/5/2004
3/1/2015
Inactive
Blackburn, Douglas Dwayne
350372
Administrator - Not Applicable
9/2/1999
10/31/2018
Inactive
Blackburn, Douglas Dwayne
350372
Agent - Health
12/31/1999
5/14/2015
Inactive
Blackburn, Douglas Dwayne
350372
Agent - Life
12/31/1999
5/14/2015
Inactive
Braun, Helmut Manfred
328248
Administrator - Not Applicable
12/12/2003
3/19/2015
Inactive
Braun, Helmut Manfred
328248
Agent - Health
1/22/2007
5/14/2015
Inactive
Braun, Helmut Manfred
328248
Agent - Life
1/22/2007
5/14/2015
Inactive
Brown, William Robert
393141
Administrator - Not Applicable
9/2/1999
3/31/2008
Inactive
Cox, Charles Clifford
364672
Administrator - Not Applicable
9/2/1999
6/30/2014
Inactive
Cox, Charles Clifford
364672
Agent - Health
12/31/1999
2/2/2004
Inactive
Cox, Charles Clifford
364672
Agent - Life
12/31/1999
2/2/2004
Inactive
Day, Karen M
327656
Administrator - Not Applicable
2/14/2001
12/6/2005
Inactive
Day, Karen M
327656
Agent - Health
12/31/1999
12/19/2003
Inactive
Day, Karen M
327656
Agent - Life
12/31/1999
12/19/2003
Inactive
Dickey, Melissa F
352554
Administrator - Not Applicable
9/2/1999
3/7/2008
Inactive
Dickey, Melissa F
352554
Agent - Health
12/31/1999
1/29/2007
Inactive
Dickey, Melissa F
352554
Agent - Life
12/31/1999
1/29/2007
Inactive
Filson, Barbara B
386575
Administrator - Not Applicable
9/2/1999
3/19/2015
Inactive
Filson, Barbara B
386575
Agent - Health
12/31/1999
5/14/2015
Inactive
Filson, Barbara B
386575
Agent - Life
12/31/1999
5/14/2015
Inactive
Holton, William O
521096
Agent - Health
3/9/2007
3/20/2012
Inactive
McCabe, Jennifer Lynne
613987
Agent - Health
3/8/2007
10/1/2007
Inactive
McCabe, Jennifer Lynne
613987
Agent - Life
3/8/2007
10/1/2007
Inactive
Parish, Stephanie Jo
631696
Agent - Health
1/29/2007
5/14/2015
Inactive
Parish, Stephanie Jo
631696
Agent - Life
1/29/2007
5/14/2015
Inactive
Pfeifle, Karin Marie
633843
Agent - Health
1/26/2007
2/1/2008
Inactive
Pfeifle, Karin Marie
633843
Agent - Life
1/26/2007
2/1/2008
Inactive
Sanger, Matthew Emerson
582796
Agent - Health
2/1/2005
6/30/2014
Inactive
Sanger, Matthew Emerson
582796
Agent - Life
2/1/2005
6/30/2014
Inactive
Strong, Kimberly Anne
319329
Administrator - Not Applicable
9/2/1999
1/31/2010
Inactive
Strong, Kimberly Anne
319329
Agent - Health
3/9/2007
1/31/2010
Inactive
Strong, Kimberly Anne
319329
Agent - Life
3/9/2007
1/31/2010
Inactive
Stump, Richard Elwood
386001
Administrator - Not Applicable
9/2/1999
12/31/2011
Inactive
Stump, Richard Elwood
386001
Agent - Health
12/31/1999
1/18/2005
Inactive
Stump, Richard Elwood
386001
Agent - Life
12/31/1999
1/18/2005
Inactive
Walker, Carol Sue
615963
Agent - Health
3/8/2007
1/12/2015
Inactive
Walker, Carol Sue
615963
Agent - Life
3/8/2007
1/12/2015
Inactive
Wardlaw, Tammy Lou
353581
Agent - Health
2/13/2003
1/5/2004
Inactive
Wardlaw, Tammy Lou
353581
Agent - Life
2/13/2003
1/4/2004
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