DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Lake Cumberland Insurance Group Inc.	DOIID	400239	NAIC NPN	7222268

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Health	12/18/1997	5/31/2003
Inactive	Resident	Agent	Life	12/18/1997	4/12/1999
* 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	Illinois Mutual Life Insurance Company	301479	Agent - Health	12/18/1997	4/12/1999
Inactive	Illinois Mutual Life Insurance Company	301479	Agent - Life	12/18/1997	4/12/1999
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	2/5/1998	5/31/2003

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Anderson, Marc Robert	367321	Agent - Health	12/18/1997	12/1/2000
Inactive	Creekmore, Charles Francis	325337	Agent - Health	12/18/1997	5/31/2003