DEPARTMENT OF INSURANCE

Affiliations

Name	Tri-State Ins Agency Inc	DOIID	400047	NAIC NPN	2110447

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Health	6/28/2012		3/31/2026
Active	Resident	Agent	Life	6/28/2012		3/31/2026
Inactive	Resident	Agent	General Lines	9/9/1991	8/15/2000
Inactive	Resident	Agent	Casualty	8/15/2000	4/22/2002
Inactive	Resident	Agent	Property	8/15/2000	4/22/2002
* 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	American Equity Investment Life Insurance Company	300389	Agent - Life	5/31/2001	12/5/2006
Inactive	American General Life Insurance Company	301585	Agent - Health	2/14/2008	3/31/2012
Inactive	American General Life Insurance Company	301585	Agent - Life	2/14/2008	3/31/2012
Inactive	American National Insurance Company	301861	Agent - Health	6/3/2015	6/14/2021
Active	American National Insurance Company	301861	Agent - Life	6/3/2015
Inactive	American Pioneer Life Insurance Company	301782	Agent - Health	7/22/1998	3/31/1999
Inactive	American Pioneer Life Insurance Company	301782	Agent - Life	7/22/1998	3/31/1999
Active	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	7/14/2012
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Health	7/14/2012	10/16/2012
Active	Anthem Life Insurance Company	301209	Agent - Health	7/14/2012
Active	Anthem Life Insurance Company	301209	Agent - Life	7/14/2012
Inactive	Bankers United Life Assurance Company	300296	Agent - Health	7/20/1995	5/17/1996
Inactive	Bankers United Life Assurance Company	300296	Agent - Life	7/20/1995	5/17/1996
Inactive	Centennial Life Insurance Company (The)	301561	Agent - Health	12/20/1995	3/31/1997
Inactive	Centennial Life Insurance Company (The)	301561	Agent - Life	12/20/1995	3/31/1997
Inactive	Conseco Health Insurance Company	301725	Agent - Health	4/25/2001	10/1/2010
Inactive	Conseco Health Insurance Company	301725	Agent - Life	5/31/2001	10/1/2010
Inactive	Conseco Insurance Company	301202	Agent - Health	11/30/2004	10/1/2010
Inactive	Conseco Insurance Company	301202	Agent - Life	11/30/2004	10/1/2010
Inactive	First Penn-Pacific Life Insurance Company	301581	Agent - Health	12/30/1997	12/16/2008
Inactive	First Penn-Pacific Life Insurance Company	301581	Agent - Life	5/31/2001	12/16/2008
Inactive	Freedom Life Insurance Company of America	300074	Agent - Health	3/31/1994	3/31/1997
Inactive	Freedom Life Insurance Company of America	300074	Agent - Life	3/31/1994	3/31/1997
Inactive	Generali - U.S. Branch	301128	Agent - Casualty	8/15/2000	3/31/2002
Inactive	Generali - U.S. Branch	301128	Agent - General Lines	9/9/1991	8/15/2000
Inactive	Generali - U.S. Branch	301128	Agent - Property	8/15/2000	3/31/2002
Inactive	Golden Rule Insurance Company	301943	Agent - Health	10/8/1986	3/31/2012
Inactive	Golden Rule Insurance Company	301943	Agent - Life	5/31/2001	3/31/2012
Inactive	Investors Heritage Life Insurance Company	300363	Agent - Health	10/8/1986	3/31/2012
Inactive	Investors Heritage Life Insurance Company	300363	Agent - Life	5/31/2001	3/31/2012
Inactive	Jackson National Life Insurance Company	300486	Agent - Life	12/11/2012	6/2/2014
Inactive	John Hancock Life Insurance Company	300821	Agent - Health	11/6/2002	12/30/2009
Inactive	John Hancock Life Insurance Company	300821	Agent - Life	11/6/2002	12/30/2009
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Health	9/19/2008	3/31/2012
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Life	9/19/2008	3/31/2012
Inactive	Kentucky Home Life Insurance Company	300477	Agent - Health	12/1/1998	12/31/2003
Inactive	Kentucky Home Life Insurance Company	300477	Agent - Life	12/1/1998	12/31/2003
Inactive	Lincoln Benefit Life Company	301110	Agent - Health	12/5/2012	7/14/2014
Inactive	Lincoln Benefit Life Company	301110	Agent - Life	12/5/2012	7/14/2014
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	4/9/1997	5/15/2006
Inactive	Nassau Life Insurance Company of Kansas	300667	Agent - Health	8/19/1982	2/26/2001
Inactive	Nassau Life Insurance Company of Kansas	300667	Agent - Life	8/19/1982	2/26/2001
Inactive	National Guardian Life Insurance Company	300596	Agent - Health	8/25/2003	4/12/2004
Inactive	National Guardian Life Insurance Company	300596	Agent - Life	8/25/2003	4/12/2004
Inactive	PacifiCare Life and Health Insurance Company	301304	Agent - Health	11/27/2008	6/24/2011
Inactive	PacifiCare Life and Health Insurance Company	301304	Agent - Life	11/27/2008	3/31/2012
Inactive	Principal Life Insurance Company	300129	Agent - Health	12/4/1997	11/30/2003
Inactive	Principal Life Insurance Company	300129	Agent - Life	12/4/1997	11/30/2003
Inactive	Progressive Max Insurance Company	301034	Agent - Casualty	8/15/2000	4/22/2002
Inactive	Progressive Max Insurance Company	301034	Agent - General Lines	8/30/1999	8/15/2000
Inactive	Progressive Max Insurance Company	301034	Agent - Property	8/15/2000	4/22/2002
Inactive	Progressive Northern Insurance Company	301378	Agent - Casualty	8/15/2000	4/22/2002
Inactive	Progressive Northern Insurance Company	301378	Agent - General Lines	8/30/1999	8/15/2000
Inactive	Progressive Northern Insurance Company	301378	Agent - Property	8/15/2000	4/22/2002
Inactive	Progressive Northwestern Insurance Company	300441	Agent - Casualty	8/15/2000	4/22/2002
Inactive	Progressive Northwestern Insurance Company	300441	Agent - General Lines	8/30/1999	8/15/2000
Inactive	Progressive Northwestern Insurance Company	300441	Agent - Property	8/15/2000	4/22/2002
Inactive	QBE Insurance Corporation	300515	Agent - General Lines	12/8/1999	6/29/2000
Inactive	Senior Health Insurance Company of Pennsylvania	300251	Agent - Health	4/26/1994	7/18/2003
Inactive	Senior Health Insurance Company of Pennsylvania	300251	Agent - Life	4/26/1994	7/18/2003
Inactive	South Carolina Insurance Company	300080	Agent - Casualty	8/15/2000	4/22/2002
Inactive	South Carolina Insurance Company	300080	Agent - General Lines	5/6/1998	8/15/2000
Inactive	South Carolina Insurance Company	300080	Agent - Property	8/15/2000	4/22/2002
Inactive	Standard Life and Accident Insurance Company	301534	Agent - Health	10/5/1989	3/31/2012
Inactive	Standard Life and Accident Insurance Company	301534	Agent - Life	5/31/2001	3/31/2012
Inactive	Sterling Investors Life Insurance Company	301785	Agent - Health	8/24/2005	3/31/2012
Inactive	Sterling Investors Life Insurance Company	301785	Agent - Life	8/24/2005	3/31/2012
Inactive	Time Insurance Company	300683	Agent - Health	1/25/2001	11/21/2002
Inactive	Time Insurance Company	300683	Agent - Life	1/25/2001	11/21/2002
Inactive	U.S. Financial Life Insurance Company	301812	Agent - Health	3/20/1996	10/22/2003
Inactive	U.S. Financial Life Insurance Company	301812	Agent - Life	3/20/1996	10/22/2003
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	11/27/2008	6/24/2011
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	11/27/2008	3/31/2012
Inactive	Venerable Insurance and Annuity Company	301006	Agent - Life	1/7/2005	12/20/2006
Inactive	Washington National Insurance Company	300587	Agent - Health	10/1/2010	12/28/2010
Inactive	Washington National Insurance Company	300587	Agent - Life	10/1/2010	12/28/2010

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Acordia of Western Kentucky Inc.	401302	Agent - Health	7/18/1996	12/31/2001
Inactive	Acordia of Western Kentucky Inc.	401302	Agent - Life	7/18/1996	12/31/2001
Inactive	Alexander, T J	343539	Agent - General Lines	8/19/1982	8/15/2000
Inactive	Alexander, T J	343539	Agent - Health	6/28/2012	5/16/2022
Inactive	Alexander, T J	343539	Agent - Life	6/28/2012	5/16/2022
Inactive	Arison Insurance Services, Inc.	401001	Agent - Health	8/17/1999	12/31/2001
Inactive	Arison Insurance Services, Inc.	401001	Agent - Life	8/17/1999	12/31/2001
Inactive	Elliott, Juanita Fawndeze	330770	Agent - Health	5/15/1991	1/31/2010
Inactive	Elliott, Juanita Fawndeze	330770	Agent - Life	5/15/1991	1/31/2010
Inactive	Felts, Jackie Ray	365662	Agent - General Lines	8/19/1982	8/15/2000
Inactive	Felts, Jackie Ray	365662	Agent - Health	7/20/2012	10/31/2015
Inactive	Felts, Jackie Ray	365662	Agent - Life	7/20/2012	10/31/2015
Inactive	Felts, James	393992	Agent - General Lines	8/19/1982	3/31/1998
Inactive	Felts, James	393992	Agent - Health	8/19/1982	3/31/2012
Inactive	Felts, James	393992	Agent - Life	8/19/1982	3/31/2012
Inactive	Felts, Stephon S	382909	Agent - Health	5/15/1991	4/16/1997
Inactive	Felts, Stephon S	382909	Agent - Life	5/15/1991	4/16/1997
Inactive	Hollan, Sara J	304428	Agent - Health	5/15/1991	7/1/2004
Inactive	Hollan, Sara J	304428	Agent - Life	5/15/1991	7/1/2004
Active	Kelley, Timothy Odaniel	362577	Agent - Health	3/30/2020
Active	Kelley, Timothy Odaniel	362577	Agent - Life	3/26/2022
Inactive	Morgan, Grey Van	311491	Agent - General Lines	5/15/1991	7/1/1996
Inactive	Morgan, Grey Van	311491	Agent - Health	3/12/2003	7/1/2006
Inactive	Morgan, Grey Van	311491	Agent - Life	3/12/2003	7/1/2006