DEPARTMENT OF INSURANCE
Affiliations
NameAdministrative Services Group Inc.
DBA : Fiserv Health-Administrative Services Group		DOIID401173NAIC NPN3662403
License - Line of Authority Information
StatusResidencyClassLine of AuthorityActive DateInactive DateLicense Expiration Date
InactiveResidentAdministratorNot Applicable9/4/19972/17/2009 
InactiveResidentAgentHealth10/8/19972/17/2009 
InactiveResidentAgentLife10/8/19972/17/2009 
* 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
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveAmerican Family Life Assurance Company of Columbus (AFLAC)301781Agent - Health12/4/20021/9/2004
InactiveAmerican Family Life Assurance Company of Columbus (AFLAC)301781Agent - Life12/4/20021/9/2004
InactiveAnthem Life Insurance Company301209Agent - Health10/8/19972/17/2009
InactiveAnthem Life Insurance Company301209Agent - Life10/8/19972/17/2009
InactiveCHA HMO, Inc.300662Agent - Health4/26/20042/17/2009
InactiveCombined Insurance Company of America301472Agent - Health1/23/20072/17/2009
InactiveCombined Insurance Company of America301472Agent - Life1/23/20072/17/2009
InactiveFort Wayne Health & Casualty Insurance Company301572Agent - Health12/9/199712/22/2004
InactiveGerber Life Insurance Company300529Agent - Health4/29/200411/15/2006
InactiveGerber Life Insurance Company300529Agent - Life4/29/200411/15/2006
InactiveHCC Life Insurance Company301827Agent - Health3/11/20052/9/2009
InactiveHCC Life Insurance Company301827Agent - Life3/11/20052/9/2009
InactiveHM Life Insurance Company301408Agent - Health2/3/200310/31/2007
InactiveHM Life Insurance Company301408Agent - Life2/3/200310/31/2007
InactiveLafayette Life Insurance Company (The)301039Agent - Health5/2/20024/7/2004
InactiveLafayette Life Insurance Company (The)301039Agent - Life5/2/20024/7/2004
InactiveLife Insurance Company of North America300711Agent - Health7/30/19982/17/2009
InactiveLife Insurance Company of North America300711Agent - Life7/30/19982/17/2009
InactiveLife Investors Insurance Company of America301793Agent - Health8/18/20037/23/2008
InactiveLife Investors Insurance Company of America301793Agent - Life8/18/20037/23/2008
InactiveMutual of Omaha Insurance Company301012Agent - Health1/9/20032/17/2009
InactiveQBE Insurance Corporation300515Agent - Health12/30/20032/17/2009
InactiveSymetra Life Insurance Company301691Agent - Health11/4/20022/17/2009
InactiveSymetra Life Insurance Company301691Agent - Life11/4/20022/17/2009
InactiveTransamerica Premier Life Insurance Company300558Agent - Health11/18/20023/21/2003
InactiveTransamerica Premier Life Insurance Company300558Agent - Life11/18/20023/21/2003
InactiveUnion Labor Life Insurance Company301832Agent - Health12/4/20007/15/2008
InactiveUnion Labor Life Insurance Company301832Agent - Life12/4/20007/15/2008
InactiveUnited of Omaha Life Insurance Company300156Agent - Health1/9/20032/17/2009
InactiveUnited of Omaha Life Insurance Company300156Agent - Life1/9/20032/17/2009
InactiveUnitedHealthcare Insurance Company300946Agent - Health4/8/200310/23/2006
InactiveUnitedHealthcare Insurance Company300946Agent - Life4/8/200310/23/2006
InactiveUnitedHealthcare of Kentucky, Ltd.301337Agent - Health4/8/200310/23/2006
InactiveUnitedHealthcare of Ohio, Inc.300493Agent - Health1/16/200410/23/2006
Designated Individuals
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveAldridge, Stephanie Renee 525523Administrator - Not Applicable4/22/20022/17/2009
InactiveAldridge, Stephanie Renee 525523Agent - Health1/5/20042/17/2009
InactiveAldridge, Stephanie Renee 525523Agent - Life1/5/20042/17/2009
InactiveBlackburn, Douglas Dwayne 350372Administrator - Not Applicable6/28/19992/17/2009
InactiveBlackburn, Douglas Dwayne 350372Agent - Health11/6/19972/17/2009
InactiveBlackburn, Douglas Dwayne 350372Agent - Life11/6/19972/17/2009
InactiveBraun, Helmut Manfred 328248Administrator - Not Applicable12/12/20032/17/2009
InactiveBraun, Helmut Manfred 328248Agent - Health1/22/20072/17/2009
InactiveBraun, Helmut Manfred 328248Agent - Life1/22/20072/17/2009
InactiveBrown, William Robert 393141Administrator - Not Applicable9/4/19973/31/2008
InactiveCox, Charles Clifford 364672Administrator - Not Applicable3/31/19992/17/2009
InactiveCox, Charles Clifford 364672Agent - Health3/22/19992/2/2004
InactiveCox, Charles Clifford 364672Agent - Life3/22/19992/2/2004
InactiveDay, Karen M 327656Administrator - Not Applicable2/14/200112/6/2005
InactiveDay, Karen M 327656Agent - Health6/14/199912/19/2003
InactiveDay, Karen M 327656Agent - Life6/14/199912/19/2003
InactiveDickey, Melissa F 352554Administrator - Not Applicable6/28/19993/7/2008
InactiveDickey, Melissa F 352554Agent - Health11/6/19971/29/2007
InactiveDickey, Melissa F 352554Agent - Life11/6/19971/29/2007
InactiveFilson, Barbara B 386575Administrator - Not Applicable6/28/19992/17/2009
InactiveFilson, Barbara B 386575Agent - Health11/6/19972/17/2009
InactiveFilson, Barbara B 386575Agent - Life11/6/19972/17/2009
InactiveHolton, William O 521096Agent - Health3/9/20072/17/2009
InactiveMcCabe, Jennifer Lynne 613987Agent - Health3/8/200710/1/2007
InactiveMcCabe, Jennifer Lynne 613987Agent - Life3/8/200710/1/2007
InactiveParish, Stephanie Jo 631696Agent - Health1/22/20072/17/2009
InactiveParish, Stephanie Jo 631696Agent - Life1/22/20072/17/2009
InactivePfeifle, Karin Marie 633843Agent - Health1/26/20072/1/2008
InactivePfeifle, Karin Marie 633843Agent - Life1/26/20072/1/2008
InactiveRamsey, Garry Rodney 362431Administrator - Not Applicable9/4/19973/31/1999
InactiveRamsey, Teresa Gail 338322Agent - Health11/6/19973/29/1999
InactiveRamsey, Teresa Gail 338322Agent - Life11/6/19973/29/1999
InactiveSanger, Matthew Emerson 582796Agent - Health2/1/20052/17/2009
InactiveSanger, Matthew Emerson 582796Agent - Life2/1/20052/17/2009
InactiveStrong, Kimberly Anne 319329Administrator - Not Applicable6/28/19992/17/2009
InactiveStrong, Kimberly Anne 319329Agent - Health3/9/20072/17/2009
InactiveStrong, Kimberly Anne 319329Agent - Life3/9/20072/17/2009
InactiveStump, Richard Elwood 386001Administrator - Not Applicable9/4/19972/17/2009
InactiveStump, Richard Elwood 386001Agent - Health10/8/19971/18/2005
InactiveStump, Richard Elwood 386001Agent - Life10/8/19971/18/2005
InactiveWalker, Carol Sue 615963Agent - Health3/8/20072/17/2009
InactiveWalker, Carol Sue 615963Agent - Life3/8/20072/17/2009

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