DEPARTMENT OF INSURANCE

Affiliations

Name	Kentucky Public Entity Programs Inc	DOIID	400082	NAIC NPN	7222150

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Casualty	7/10/2013		3/31/2027
Active	Resident	Agent	Property	7/10/2013		3/31/2027
Active	Resident	Agent	Life	3/20/2014		3/31/2027
Active	Resident	Agent	Health	3/20/2014		3/31/2027
Inactive	Resident	Agent	Health Maintenance Organization	7/7/1998	3/1/2001
Inactive	Resident	Agent	General Lines	5/18/1987	8/15/2000
Inactive	Resident	Agent	Prepaid Dental Plan	11/15/1999	3/1/2001
* 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	01/15/2025	03/31/2025	01/15/2025	01/15/2025	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	ACE American Insurance Company	300625	Agent - General Lines	5/18/1987	3/31/1998
Inactive	ACE Fire Underwriters Insurance Company	301679	Agent - General Lines	5/18/1987	3/31/1998
Inactive	ACE Property and Casualty Insurance Company	300520	Agent - General Lines	5/18/1987	3/31/1998
Inactive	Aetna Life Insurance Company	301140	Agent - Health	2/18/1997	7/1/2002
Inactive	Aetna Life Insurance Company	301140	Agent - Life	2/18/1997	6/10/2004
Inactive	American Alternative Insurance Corporation	301697	Agent - Casualty	2/27/2014	5/19/2021
Inactive	American Alternative Insurance Corporation	301697	Agent - General Lines	6/6/1996	8/15/2000
Inactive	American Alternative Insurance Corporation	301697	Agent - Property	2/27/2014	5/19/2021
Inactive	American General Life Insurance Company	301585	Agent - Health	4/23/2014	1/18/2018
Inactive	American General Life Insurance Company	301585	Agent - Life	4/23/2014	1/18/2018
Denied	American General Life Insurance Company of Delaware	301057	Agent - Health
Inactive	American General Life Insurance Company of Delaware	301057	Agent - Life	8/5/2003	12/31/2012
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	12/21/2001	7/1/2002
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Health	12/21/2001	7/1/2002
Inactive	Anthem Life Insurance Company	301209	Agent - Health	4/17/1996	7/1/2002
Inactive	Anthem Life Insurance Company	301209	Agent - Life	4/17/1996	3/31/2013
Inactive	Assurity Life Insurance Company	301099	Agent - Health	5/29/2001	7/1/2002
Inactive	Assurity Life Insurance Company	301099	Agent - Life	5/29/2001	12/18/2002
Inactive	Bankers Standard Insurance Company	301620	Agent - General Lines	5/18/1987	3/31/1998
Inactive	Century Indemnity Company	301310	Agent - General Lines	5/18/1987	3/31/1998
Inactive	Charter Oak Fire Insurance Company (The)	301501	Agent - Casualty	11/24/2010	3/31/2013
Inactive	Charter Oak Fire Insurance Company (The)	301501	Agent - Property	11/24/2010	3/31/2013
Active	Combined Insurance Company of America	301472	Agent - Health	3/25/2014
Active	Combined Insurance Company of America	301472	Agent - Life	3/25/2014
Inactive	CompDent Corporation	301387	Agent - Health	3/1/2001	7/1/2002
Inactive	CompDent Corporation	301387	Agent - Prepaid Dental Plan	11/15/1999	3/1/2001
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	3/26/2007	11/27/2010
Inactive	EMC National Life Company	300388	Agent - Health	8/20/2007	2/6/2013
Inactive	EMC National Life Company	300388	Agent - Life	6/10/2002	2/6/2013
Inactive	Employers Mutual Casualty Company	300202	Agent - Casualty	4/3/2006	8/28/2008
Inactive	Employers Mutual Casualty Company	300202	Agent - Property	4/3/2006	8/28/2008
Inactive	Farmington Casualty Company	301137	Agent - Casualty	11/24/2010	3/31/2013
Inactive	Farmington Casualty Company	301137	Agent - Property	11/24/2010	3/31/2013
Inactive	Fidelity & Guaranty Life Insurance Company	301359	Agent - Health	9/18/1996	3/31/1997
Inactive	Fidelity & Guaranty Life Insurance Company	301359	Agent - Life	9/18/1996	3/31/1997
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Health	12/4/1999	7/1/2002
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Life	12/4/1999	3/13/2003
Inactive	Fidelity and Guaranty Insurance Company	301009	Agent - Casualty	8/15/2000	7/1/2002
Inactive	Fidelity and Guaranty Insurance Company	301009	Agent - General Lines	12/30/1998	8/15/2000
Inactive	Fidelity and Guaranty Insurance Company	301009	Agent - Property	8/15/2000	7/1/2002
Inactive	Fidelity and Guaranty Insurance Underwriters Inc.	300559	Agent - Casualty	8/15/2000	7/1/2002
Inactive	Fidelity and Guaranty Insurance Underwriters Inc.	300559	Agent - General Lines	12/30/1998	8/15/2000
Inactive	Fidelity and Guaranty Insurance Underwriters Inc.	300559	Agent - Property	8/15/2000	7/1/2002
Inactive	First Colony Life Insurance Company	301179	Agent - Life	5/8/1998	8/13/2001
Inactive	First National Insurance Company of America	301690	Agent - General Lines	1/23/1992	3/31/1996
Inactive	General Insurance Company of America	300261	Agent - General Lines	1/23/1992	3/31/1996
Inactive	Hamilton Mutual Insurance Company	301111	Agent - Casualty	4/3/2006	8/28/2008
Inactive	Hamilton Mutual Insurance Company	301111	Agent - Property	4/3/2006	8/28/2008
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Health	5/8/2000	7/1/2002
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Life	5/8/2000	6/4/2010
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	3/26/2007	11/27/2010
Inactive	Humana Health Plan, Inc.	300142	Agent - Health Maintenance Organization	7/7/1998	3/1/2001
Inactive	Humana Insurance Company	301104	Agent - Health	3/26/2007	11/27/2010
Inactive	Humana Insurance Company	301104	Agent - Life	7/7/1998	11/27/2010
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	3/26/2007	11/27/2010
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	3/26/2007	11/27/2010
Inactive	HumanaDental Insurance Company	301457	Agent - Health	3/26/2007	11/27/2010
Inactive	HumanaDental Insurance Company	301457	Agent - Life	3/26/2007	11/27/2010
Inactive	Indemnity Insurance Company of North America	301760	Agent - General Lines	5/18/1987	3/31/1998
Inactive	Insurance Company of North America	300226	Agent - General Lines	5/18/1987	3/31/1998
Inactive	Jefferson Pilot Financial Insurance Company	300756	Agent - Health	8/8/2001	7/1/2002
Inactive	Jefferson Pilot Financial Insurance Company	300756	Agent - Life	8/8/2001	7/2/2007
Inactive	Jefferson-Pilot Life Insurance Company	300379	Agent - Health	12/4/1999	7/1/2002
Inactive	Jefferson-Pilot Life Insurance Company	300379	Agent - Life	12/4/1999	4/2/2007
Inactive	Kanawha Insurance Company	300127	Agent - Health	4/11/2008	11/27/2010
Inactive	Kanawha Insurance Company	300127	Agent - Life	4/11/2008	11/27/2010
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Health	3/22/2007	3/31/2013
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Life	3/22/2007	3/31/2013
Active	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	300959	Agent - Casualty	7/11/2016
Inactive	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	300959	Agent - General Lines	5/27/1987	8/15/2000
Active	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	300959	Agent - Health	7/20/2016
Active	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	300959	Agent - Property	7/11/2016
Inactive	National Western Life Insurance Company	301515	Agent - Health	5/8/1998	7/1/2002
Inactive	National Western Life Insurance Company	301515	Agent - Life	5/8/1998	7/21/2005
Inactive	Old Line Life Insurance Company of America (The)	301709	Agent - Health	10/2/1998	7/1/2002
Inactive	Old Line Life Insurance Company of America (The)	301709	Agent - Life	10/2/1998	10/4/2002
Inactive	PacifiCare Life Assurance Company	301082	Agent - Health	6/17/1998	7/31/2001
Inactive	PacifiCare Life Assurance Company	301082	Agent - Life	6/17/1998	7/31/2001
Inactive	Pacific Employers Insurance Company	301753	Agent - General Lines	5/18/1987	3/31/1998
Inactive	SAFECO Insurance Company of America	300159	Agent - General Lines	1/23/1992	3/31/1996
Inactive	St. Paul Fire and Marine Insurance Company	300782	Agent - Casualty	8/15/2000	7/1/2002
Inactive	St. Paul Fire and Marine Insurance Company	300782	Agent - General Lines	12/30/1998	8/15/2000
Inactive	St. Paul Fire and Marine Insurance Company	300782	Agent - Property	8/15/2000	7/1/2002
Inactive	St. Paul Guardian Insurance Company	301372	Agent - Casualty	8/15/2000	7/1/2002
Inactive	St. Paul Guardian Insurance Company	301372	Agent - General Lines	12/30/1998	8/15/2000
Inactive	St. Paul Guardian Insurance Company	301372	Agent - Property	8/15/2000	7/1/2002
Inactive	St. Paul Mercury Insurance Company	300783	Agent - Casualty	8/15/2000	7/1/2002
Inactive	St. Paul Mercury Insurance Company	300783	Agent - General Lines	12/30/1998	8/15/2000
Inactive	St. Paul Mercury Insurance Company	300783	Agent - Property	8/15/2000	7/1/2002
Inactive	Standard Fire Insurance Company (The)	301068	Agent - Casualty	11/24/2010	3/31/2013
Inactive	Standard Fire Insurance Company (The)	301068	Agent - Property	11/24/2010	3/31/2013
Denied	Standard Insurance Company	300185	Agent - Health
Inactive	Standard Insurance Company	300185	Agent - Life	9/9/2002	3/31/2013
Inactive	Talcott Resolution Life Insurance Company	301759	Agent - Health	5/8/2000	7/1/2002
Inactive	Talcott Resolution Life Insurance Company	301759	Agent - Life	5/8/2000	6/4/2010
Inactive	The Phoenix Insurance Company	301502	Agent - Casualty	11/24/2010	3/31/2013
Inactive	The Phoenix Insurance Company	301502	Agent - Property	11/24/2010	3/31/2013
Inactive	Titan Indemnity Company	300556	Agent - Casualty	8/15/2000	3/31/2002
Inactive	Titan Indemnity Company	300556	Agent - General Lines	12/30/1998	8/15/2000
Inactive	Titan Indemnity Company	300556	Agent - Property	8/15/2000	3/31/2002
Inactive	Travelers Casualty Insurance Company of America	300522	Agent - Casualty	11/24/2010	3/31/2013
Inactive	Travelers Casualty Insurance Company of America	300522	Agent - Property	11/24/2010	3/31/2013
Inactive	Travelers Casualty and Surety Company	301067	Agent - Casualty	11/24/2010	3/31/2013
Inactive	Travelers Casualty and Surety Company	301067	Agent - Property	11/24/2010	3/31/2013
Inactive	Travelers Indemnity Company (The)	301855	Agent - Casualty	11/24/2010	3/31/2013
Inactive	Travelers Indemnity Company (The)	301855	Agent - Property	11/24/2010	3/31/2013
Inactive	Travelers Indemnity Company of America (The)	301093	Agent - Casualty	11/24/2010	3/31/2013
Inactive	Travelers Indemnity Company of America (The)	301093	Agent - Property	11/24/2010	3/31/2013
Inactive	Travelers Indemnity Company of Connecticut (The)	301591	Agent - Casualty	11/24/2010	3/31/2013
Inactive	Travelers Indemnity Company of Connecticut (The)	301591	Agent - Property	11/24/2010	3/31/2013
Inactive	Travelers Property Casualty Company of America	301649	Agent - Casualty	11/24/2010	3/31/2013
Inactive	Travelers Property Casualty Company of America	301649	Agent - Property	11/24/2010	3/31/2013
Inactive	USG Annuity & Life Company	300457	Agent - Health	5/8/1996	7/1/2002
Inactive	USG Annuity & Life Company	300457	Agent - Life	5/8/1996	8/7/2003
Inactive	United States Fidelity and Guaranty Company	301449	Agent - Casualty	8/15/2000	7/1/2002
Inactive	United States Fidelity and Guaranty Company	301449	Agent - General Lines	12/30/1998	8/15/2000
Inactive	United States Fidelity and Guaranty Company	301449	Agent - Property	8/15/2000	7/1/2002
Inactive	United States Life Insurance Company in the City of New York	301126	Agent - Health	6/8/1998	6/6/2001
Inactive	United States Life Insurance Company in the City of New York	301126	Agent - Life	6/8/1998	6/6/2001

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Arison Insurance Services, Inc.	401001	Agent - Health	4/5/1996	12/31/2001
Inactive	Arison Insurance Services, Inc.	401001	Agent - Life	4/5/1996	12/31/2001
Inactive	Glatfelter, Arthur J	373655	Agent - Life	8/8/1994	2/17/2003
Active	Siereveld, Clayton T	647888	Agent - Casualty	2/27/2014
Active	Siereveld, Clayton T	647888	Agent - Health	3/20/2014
Active	Siereveld, Clayton T	647888	Agent - Life	3/20/2014
Active	Siereveld, Clayton T	647888	Agent - Property	2/27/2014
Inactive	Siereveld, Steven Arthur	348028	Agent - Casualty	7/10/2013	11/30/2013
Inactive	Siereveld, Steven Arthur	348028	Agent - General Lines	5/18/1987	8/15/2000
Inactive	Siereveld, Steven Arthur	348028	Agent - Health	7/10/2013	11/30/2013
Inactive	Siereveld, Steven Arthur	348028	Agent - Life	7/10/2013	11/30/2013
Inactive	Siereveld, Steven Arthur	348028	Agent - Property	7/10/2013	11/30/2013