DEPARTMENT OF INSURANCE

Affiliations

Name	Park Community Credit Union	DOIID	525931	NAIC NPN	7223321

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Limited Line Credit	4/30/2001		3/31/2027
Inactive	Resident	Agent	Life	12/21/2004	10/1/2020
Inactive	Resident	Agent	Health	12/21/2004	10/1/2020
Inactive	Resident	Agent	Variable Life and Variable Annuities	1/19/2005	10/1/2020
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Notice: The Department verifies, at the time of application for a Variable Life and Variable Annuity line of authority, that an agent is registered with the Financial Industry Regulatory Authority (FINRA) and the applicant has passed the Series 6 or greater exam. The Department does not verify registration with FINRA after the agent is qualified by the Department to receive the Variable Life and Variable Annuity line of authority. If you have questions about a broker’s FINRA registration status, you should check this status directly with FINRA.

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	American General Life Insurance Company	301585	Agent - Health	1/11/2006	3/1/2012
Inactive	American General Life Insurance Company	301585	Agent - Life	1/11/2006	3/1/2012
Inactive	American Investors Life Insurance Company, Inc.	301358	Agent - Life	5/22/2009	10/14/2009
Inactive	American National Insurance Company	301861	Agent - Health	12/13/2005	10/1/2020
Inactive	American National Insurance Company	301861	Agent - Life	12/13/2005	10/1/2020
Inactive	Annuity Investors Life Insurance Company	300715	Agent - Life	6/30/2006	12/22/2008
Inactive	Athene Annuity and Life Company	301893	Agent - Health	10/14/2009	11/2/2009
Inactive	Athene Annuity and Life Company	301893	Agent - Life	10/14/2009	7/10/2014
Inactive	Athene Annuity and Life Company	301893	Agent - Limited Line Credit	10/14/2009	11/2/2009
Inactive	Athene Annuity and Life Company	301893	Agent - Variable Life and Variable Annuities	10/14/2009	11/2/2009
Inactive	CMFG Life Insurance Company	300929	Agent - Health	9/19/2007	3/20/2012
Inactive	CMFG Life Insurance Company	300929	Agent - Life	9/19/2007	3/20/2012
Active	CMFG Life Insurance Company	300929	Agent - Limited Line Credit	4/30/2001
Inactive	CMFG Life Insurance Company	300929	Agent - Variable Life and Variable Annuities	9/19/2007	3/20/2012
Inactive	CUNA Mutual Life Insurance Company	301467	Agent - Health	1/5/2005	12/31/2007
Inactive	CUNA Mutual Life Insurance Company	301467	Agent - Life	1/5/2005	12/31/2007
Inactive	CUNA Mutual Life Insurance Company	301467	Agent - Variable Life and Variable Annuities	2/8/2006	12/31/2007
Inactive	Fidelity & Guaranty Life Insurance Company	301359	Agent - Health	10/8/2007	3/7/2012
Inactive	Fidelity & Guaranty Life Insurance Company	301359	Agent - Life	10/8/2007	3/7/2012
Inactive	Golden Rule Insurance Company	301943	Agent - Health	12/28/2005	11/10/2008
Inactive	Golden Rule Insurance Company	301943	Agent - Life	12/28/2005	11/10/2008
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Health	4/26/2010	10/1/2020
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Life	4/26/2010	10/1/2020
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Health	12/5/2005	10/1/2020
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Life	12/5/2005	10/1/2020
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Variable Life and Variable Annuities	3/22/2007	10/1/2020
Inactive	MassMutual Ascend Life Insurance Company	300320	Agent - Life	6/30/2006	12/22/2008
Inactive	Minnesota Life Insurance Company	300488	Agent - Health	2/11/2009	10/1/2020
Inactive	Minnesota Life Insurance Company	300488	Agent - Life	2/11/2009	10/1/2020
Inactive	National Western Life Insurance Company	301515	Agent - Life	12/19/2005	2/14/2007
Inactive	North American Company for Life and Health Insurance	300291	Agent - Health	3/14/2008	12/1/2010
Inactive	North American Company for Life and Health Insurance	300291	Agent - Life	3/14/2008	12/1/2010
Inactive	Protective Life Insurance Company	300638	Agent - Life	1/1/2007	12/22/2010
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	3/16/2010	12/15/2011
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	3/16/2010	12/15/2011
Inactive		300277	Agent - Life	12/6/2005	1/1/2007

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Bailey, Layne L	525554	Agent - Limited Line Credit	4/30/2001	9/23/2002
Inactive	Bass, Dee	385571	Agent - Limited Line Credit	4/30/2001	7/31/2006
Inactive	Beamus, Sherlyn	517650	Agent - Limited Line Credit	9/16/2020	11/16/2020
Inactive	Brangers, Lisa Marie	699874	Agent - Limited Line Credit	2/17/2009	11/1/2013
Inactive	Brown, Charlotte Lynn	389361	Agent - Limited Line Credit	3/9/2007	2/28/2011
Inactive	Burnell, Jocelyn F	368130	Agent - Limited Line Credit	3/9/2007	3/31/2014
Inactive	Cassedy-Crutcher, D. Jean	351189	Agent - Limited Line Credit	4/30/2001	2/13/2003
Active	Chambers, Katie	807314	Agent - Limited Line Credit	9/16/2020
Inactive	Combs, Phyllis Regenauer	525883	Agent - Limited Line Credit	4/30/2001	3/9/2009
Inactive	Daniel, Lundi Ann	525884	Agent - Limited Line Credit	4/30/2001	2/13/2003
Inactive	Derringer, Rita K	525732	Agent - Limited Line Credit	4/30/2001	4/25/2007
Inactive	Dooley, Denise Frances	601520	Agent - Limited Line Credit	3/9/2007	2/28/2011
Inactive	Dunbar, Sharon S	525731	Agent - Limited Line Credit	4/30/2001	1/26/2013
Inactive	Eib, David T	534339	Agent - Limited Line Credit	3/9/2007	3/9/2009
Inactive	Ellington, Carmen Kay	303849	Agent - Limited Line Credit	4/30/2001	1/17/2005
Inactive	Estes, Annette M	546718	Agent - Limited Line Credit	3/9/2007	2/26/2015
Inactive	Fallon, Ed J	624013	Agent - Limited Line Credit	3/9/2007	10/15/2018
Inactive	Floyd, Amber	839602	Agent - Limited Line Credit	9/16/2020	6/4/2024
Inactive	Gaines, Vickie Lee	546715	Agent - Limited Line Credit	3/9/2007	2/28/2011
Inactive	Hammond, Teresa Gail	304091	Agent - Limited Line Credit	4/30/2001	10/15/2018
Inactive	Herren, Margaret W	525725	Agent - Limited Line Credit	4/30/2001	10/15/2018
Inactive	Highbaugh, Leigh	928445	Agent - Limited Line Credit	9/16/2020	1/31/2022
Inactive	Hollkamp, Patti M	636162	Agent - Limited Line Credit	3/9/2007	10/15/2018
Inactive	House, Natalie Lynn	612343	Agent - Limited Line Credit	3/9/2007	10/15/2018
Inactive	Hudson, Penelope Lea	636163	Agent - Limited Line Credit	3/9/2007	12/29/2016
Inactive	Jacobs, Tiffany D	612344	Agent - Limited Line Credit	3/9/2007	6/21/2007
Inactive	Jaskowiak, Amber	1057629	Agent - Limited Line Credit	9/16/2020	4/30/2023
Inactive	Johnson, Toni Y	526614	Agent - Limited Line Credit	11/21/2005	10/15/2018
Inactive	Klusmeier, Deborah Lynn	534157	Agent - Limited Line Credit	7/30/2007	10/15/2018
Inactive	Louden, Marilyn Nancy	526613	Agent - Limited Line Credit	11/21/2005	8/31/2010
Inactive	Lyons, Michelle Christine	525733	Agent - Limited Line Credit	4/30/2001	2/13/2003
Inactive	Marks, Jennifer Diane	546723	Agent - Limited Line Credit	3/9/2007	2/23/2013
Inactive	Morris, Phil	332582	Agent - Limited Line Credit	4/30/2001	7/11/2013
Inactive	Musgrove, Barbara R	525542	Agent - Limited Line Credit	4/30/2001	2/28/2014
Active	Oliverio-Garr, Heather	805921	Agent - Limited Line Credit	9/16/2020
Inactive	Owings, James Larry	365154	Agent - Health	12/21/2004	7/31/2020
Inactive	Owings, James Larry	365154	Agent - Life	12/21/2004	7/31/2020
Inactive	Owings, James Larry	365154	Agent - Variable Life and Variable Annuities	1/19/2005	7/31/2020
Inactive	Patterson, Patricia Selena	568914	Agent - Limited Line Credit	3/9/2007	10/30/2012
Active	Phelan, Sarah	1096107	Agent - Limited Line Credit	10/10/2020
Inactive	Pierce, Karen Lynn	325484	Agent - Limited Line Credit	4/30/2001	7/17/2009
Inactive	Rawlins, Ashley Nicole	525729	Agent - Limited Line Credit	4/30/2001	3/7/2002
Inactive	Resor, Heather Renee	601530	Agent - Limited Line Credit	3/9/2007	10/15/2018
Inactive	Ritter, Helen L	525556	Agent - Limited Line Credit	4/30/2001	9/23/2002
Inactive	Sanchez, Mario	974561	Agent - Limited Line Credit	9/16/2020	11/29/2022
Inactive	Sandlin, Patricia A	525538	Agent - Limited Line Credit	4/30/2001	11/30/2004
Inactive	Scherzinger, Daryl Lee	525420	Agent - Limited Line Credit	4/30/2001	1/19/2005
Inactive	Simons, Brandy Lea	525735	Agent - Limited Line Credit	4/30/2001	9/23/2002
Inactive	Spiller, Jane	525540	Agent - Limited Line Credit	4/30/2001	9/23/2002
Inactive	Spradlin, James E	321500	Agent - Limited Line Credit	4/30/2001	12/31/2009
Inactive	Stigall, David Price	525885	Agent - Limited Line Credit	5/31/2001	12/31/2006
Active	Street, Kristen	845539	Agent - Limited Line Credit	9/16/2020
Inactive	Watkins-Bosse, Bridget	612419	Agent - Limited Line Credit	3/9/2007	10/15/2018
Inactive	White, Terri L	525734	Agent - Limited Line Credit	4/30/2001	4/25/2007
Inactive	Willis, Julie M	636179	Agent - Limited Line Credit	3/9/2007	10/26/2020
Inactive	Willoughby, Tena	311932	Agent - Limited Line Credit	4/30/2001	5/6/2010
Inactive	Win'e, Sonia L	525887	Agent - Limited Line Credit	5/31/2001	7/31/2012