DEPARTMENT OF INSURANCE

Affiliations

Name	Bruckman, Adam D	DOIID	553893	NAIC NPN	1015391

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Life	8/22/2002	5/31/2026
Active	Non Resident	Agent	Health	8/22/2002	5/31/2026
* 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	03/15/2024	05/31/2024	05/06/2024	05/06/2024	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Aetna Health Inc.	300694	Agent - Health	9/26/2002	12/31/2007
Active	Aetna Health Inc. (PA)	660717	Agent - Health	12/31/2007
Active	Aetna Life Insurance Company	301140	Agent - Health	8/22/2002
Active	Aetna Life Insurance Company	301140	Agent - Life	8/22/2002
Active	All Savers Insurance Company	301940	Agent - Health	8/23/2017
Active	All Savers Insurance Company	301940	Agent - Life	8/23/2017
Active	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	9/30/2014
Active	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	9/30/2014
Inactive	American Fidelity Assurance Company	301004	Agent - Health	1/5/2012	2/26/2015
Inactive	American Fidelity Assurance Company	301004	Agent - Life	1/5/2012	2/26/2015
Active	American General Life Insurance Company	301585	Agent - Health	11/15/2021
Active	American General Life Insurance Company	301585	Agent - Life	11/15/2021
Inactive	American Public Life Insurance Company	300252	Agent - Health	2/5/2021	1/23/2023
Inactive	American Public Life Insurance Company	300252	Agent - Life	2/5/2021	1/23/2023
Active	American United Life Insurance Company	300498	Agent - Health	8/31/2011
Active	American United Life Insurance Company	300498	Agent - Life	8/31/2011
Active	Banner Life Insurance Company	301696	Agent - Life	2/11/2003
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Health	10/22/2019	10/5/2021
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Life	10/22/2019	10/5/2021
Inactive	Chase Insurance Life and Annuity Company	300518	Agent - Health	4/1/2003	4/1/2007
Inactive	Chase Insurance Life and Annuity Company	300518	Agent - Life	4/1/2003	4/1/2007
Active	Citizens Security Life Insurance Company	301257	Agent - Health	9/7/2010
Active	Citizens Security Life Insurance Company	301257	Agent - Life	9/7/2010
Active	Colonial Life and Accident Insurance Company	300846	Agent - Health	12/4/2015
Active	Colonial Life and Accident Insurance Company	300846	Agent - Life	12/4/2015
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	7/28/2009	3/14/2019
Active	CompBenefits Insurance Company	301864	Agent - Health	9/15/2020
Inactive	CompBenefits Insurance Company	301864	Agent - Life	7/28/2009	7/2/2013
Inactive	CompDent Corporation	301387	Agent - Health	7/2/2004	12/23/2004
Inactive	Connecticut General Life Insurance Company	301333	Agent - Health	10/28/2002	6/11/2014
Inactive	Connecticut General Life Insurance Company	301333	Agent - Life	10/28/2002	6/11/2014
Inactive	Continental Casualty Company	301019	Agent - Health	8/30/2023	9/1/2023
Inactive	Continental General Insurance Company	300691	Agent - Health	8/9/2018	1/25/2019
Inactive	Continental General Insurance Company	300691	Agent - Life	8/9/2018	1/25/2019
Active	Dearborn Life Insurance Company	300401	Agent - Health	7/23/2007
Active	Dearborn Life Insurance Company	300401	Agent - Life	7/23/2007
Active	Dental Care Plus Inc.	301495	Agent - Health	3/10/2009
Active	Dental Concern Inc. (The)	301641	Agent - Health	3/18/2021
Inactive	DentiCare, Inc.	300655	Agent - Health	6/18/2003	11/1/2005
Active	Fidelity Security Life Insurance Company	300466	Agent - Health	2/2/2012
Active	Fidelity Security Life Insurance Company	300466	Agent - Life	2/2/2012
Inactive	First Penn-Pacific Life Insurance Company	301581	Agent - Health	9/28/2002	10/8/2004
Inactive	First Penn-Pacific Life Insurance Company	301581	Agent - Life	9/28/2002	10/8/2004
Active	Golden Rule Insurance Company	301943	Agent - Health	6/25/2013
Active	Golden Rule Insurance Company	301943	Agent - Life	6/25/2013
Active	Guardian Life Insurance Company of America	301316	Agent - Health	10/22/2019
Active	Guardian Life Insurance Company of America	301316	Agent - Life	10/22/2019
Inactive	HCC Life Insurance Company	301827	Agent - Health	11/2/2016	9/21/2017
Active	Hartford Life and Accident Insurance Company	300878	Agent - Health	12/27/2002
Active	Hartford Life and Accident Insurance Company	300878	Agent - Life	12/27/2002
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	9/10/2020	12/15/2020
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	9/10/2020	12/15/2020
Active	Humana Health Plan, Inc.	300142	Agent - Health	12/12/2002
Active	Humana Insurance Company	301104	Agent - Health	12/30/2020
Inactive	Humana Insurance Company	301104	Agent - Life	12/26/2018	12/19/2019
Active	Humana Insurance Company of Kentucky	300826	Agent - Health	12/30/2020
Active	Humana Insurance Company of Kentucky	300826	Agent - Life	12/30/2020
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	9/10/2020	12/15/2020
Inactive	Humana Wisconsin Health Organization Insurance Corporation	830687	Agent - Health	9/10/2020	12/15/2020
Inactive	HumanaDental Insurance Company	301457	Agent - Health	2/12/2010	5/13/2013
Inactive	HumanaDental Insurance Company	301457	Agent - Life	2/12/2010	5/13/2013
Inactive	John Alden Life Insurance Company	300573	Agent - Health	9/18/2008	1/24/2013
Inactive	John Alden Life Insurance Company	300573	Agent - Life	9/18/2008	1/24/2013
Inactive	Kanawha Insurance Company	300127	Agent - Health	12/30/2008	8/9/2018
Inactive	Kanawha Insurance Company	300127	Agent - Life	12/30/2008	8/9/2018
Active	Lincoln National Life Insurance Company (The)	301382	Agent - Health	9/13/2018
Active	Lincoln National Life Insurance Company (The)	301382	Agent - Life	9/13/2018
Inactive	Metropolitan Life Insurance Company	301948	Agent - Health	8/17/2005	12/12/2014
Inactive	Metropolitan Life Insurance Company	301948	Agent - Life	8/17/2005	12/12/2014
Active	National Guardian Life Insurance Company	300596	Agent - Health	9/5/2007
Inactive	National Guardian Life Insurance Company	300596	Agent - Life	9/5/2007	7/7/2020
Inactive	National Health Insurance Company	300554	Agent - Health	1/6/2017	12/28/2020
Active	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	300959	Agent - Health	2/18/2015
Active	Nationwide Life Insurance Company	300495	Agent - Health	11/16/2011
Active	Nationwide Life Insurance Company	300495	Agent - Life	11/16/2011
Inactive	North American Company for Life and Health Insurance	300291	Agent - Life	10/22/2012	5/14/2018
Inactive	Peoples Benefit Life Insurance Company	301895	Agent - Health	10/28/2002	1/21/2003
Inactive	Peoples Benefit Life Insurance Company	301895	Agent - Life	10/28/2002	1/21/2003
Active	Principal Life Insurance Company	300129	Agent - Health	8/8/2003
Active	Principal Life Insurance Company	300129	Agent - Life	8/8/2003
Inactive	Protective Life Insurance Company	300638	Agent - Health	4/1/2007	12/28/2009
Inactive	Protective Life Insurance Company	300638	Agent - Life	4/1/2007	12/28/2009
Active	Provident Life and Accident Insurance Company	301525	Agent - Health	9/2/2010
Active	Provident Life and Accident Insurance Company	301525	Agent - Life	9/2/2010
Active	Reliance Standard Life Insurance Company	300584	Agent - Health	2/1/2011
Active	Reliance Standard Life Insurance Company	300584	Agent - Life	2/1/2011
Active	Standard Insurance Company	300185	Agent - Health	9/21/2010
Active	Standard Insurance Company	300185	Agent - Life	9/21/2010
Active	Sun Life Assurance Company of Canada	301811	Agent - Health	9/26/2008
Active	Sun Life Assurance Company of Canada	301811	Agent - Life	9/26/2008
Inactive	Sun Life and Health Insurance Company (U.S.)	300801	Agent - Health	12/26/2002	2/8/2005
Inactive	Sun Life and Health Insurance Company (U.S.)	300801	Agent - Life	12/26/2002	2/8/2005
Active	Superior Dental Care Inc.	300418	Agent - Health	2/4/2011
Inactive	Time Insurance Company	300683	Agent - Health	10/27/2014	11/23/2019
Inactive	Time Insurance Company	300683	Agent - Life	10/27/2014	11/23/2019
Active	Transamerica Life Insurance Company	300571	Agent - Health	4/13/2010
Active	Transamerica Life Insurance Company	300571	Agent - Life	4/13/2010
Active	UNUM Life Insurance Company of America	300817	Agent - Health	9/2/2010
Active	UNUM Life Insurance Company of America	300817	Agent - Life	9/2/2010
Inactive	Union Security Insurance Company	301844	Agent - Health	11/1/2005	3/13/2013
Active	United Concordia Insurance Company	903543	Agent - Health	12/31/2017
Inactive	United Concordia Life and Health Insurance Company	301220	Agent - Health	10/6/2015	12/31/2017
Active	United of Omaha Life Insurance Company	300156	Agent - Health	10/29/2002
Active	United of Omaha Life Insurance Company	300156	Agent - Life	10/29/2002
Active	UnitedHealthcare Insurance Company	300946	Agent - Health	6/26/2024
Active	UnitedHealthcare Insurance Company	300946	Agent - Life	6/26/2024
Inactive	UnitedHealthcare Life Insurance Company	301517	Agent - Health	11/12/2015	10/18/2016
Inactive	UnitedHealthcare Life Insurance Company	301517	Agent - Life	11/12/2015	10/18/2016
Active	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	6/26/2024
Active	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	6/26/2024
Inactive	Wilton Reassurance Life Company of New York	300163	Agent - Life	1/21/2003	6/8/2006

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Centro Benefits Research LLC	1073780	Agent - Health	2/10/2020
Active	Centro Benefits Research LLC	1073780	Agent - Life	2/10/2020
Active	Dental Choice Agency Inc.	398085	Agent - Health	7/9/2007
Active	Designated Agent Company Inc.	681257	Agent - Health	12/2/2013
Active	Designated Agent Company Inc.	681257	Agent - Life	12/2/2013
Active	Digital Insurance LLC	521672	Agent - Health	9/20/2002
Active	Digital Insurance LLC	521672	Agent - Life	9/20/2002
Active	Kistler Tiffany Benefits General Agency LLC	1074480	Agent - Health	2/14/2020
Active	Kistler Tiffany Benefits General Agency LLC	1074480	Agent - Life	2/14/2020
Inactive	Medlink Inc	400721	Agent - Health	5/13/2004	3/31/2024
Inactive	Medlink Inc	400721	Agent - Life	5/13/2004	3/31/2024