DEPARTMENT OF INSURANCE

Affiliations

Name	Lacy, Kristy Lynn	DOIID	579702	NAIC NPN	7917457

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Life	11/22/2010	12/1/2013
Inactive	Resident	Agent	Health	11/22/2010	12/1/2013
* 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	American Continental Insurance Company	643130	Agent - Health	3/23/2007	11/30/2009
Inactive	American Continental Insurance Company	643130	Agent - Life	12/5/2006	11/30/2009
Inactive	American General Life and Accident Insurance Company	301362	Agent - Health	11/18/2003	4/16/2004
Inactive	American General Life and Accident Insurance Company	301362	Agent - Life	11/18/2003	4/16/2004
Inactive	Combined Insurance Company of America	301472	Agent - Health	8/1/2011	11/28/2011
Inactive	Combined Insurance Company of America	301472	Agent - Life	8/1/2011	11/28/2011
Inactive	Continental General Insurance Company	300691	Agent - Health	12/5/2006	11/28/2008
Inactive	Continental General Insurance Company	300691	Agent - Life	12/5/2006	11/28/2008
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	3/23/2007	12/12/2008
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Life	3/23/2007	12/12/2008
Inactive	Lincoln Heritage Life Insurance Company	500016	Agent - Health	5/18/2004	9/12/2004
Inactive	Lincoln Heritage Life Insurance Company	500016	Agent - Life	5/18/2004	9/12/2004
Inactive	Marquette National Life Insurance Company	300117	Agent - Health	10/17/2011	9/13/2012
Inactive	Marquette National Life Insurance Company	300117	Agent - Life	10/17/2011	9/13/2012
Inactive	MassMutual Ascend Life Insurance Company	300320	Agent - Health	12/21/2006	5/15/2007
Inactive	MassMutual Ascend Life Insurance Company	300320	Agent - Life	4/19/2007	5/15/2007
Inactive	Nassau Life Insurance Company of Kansas	300667	Agent - Health	10/17/2011	12/13/2012
Inactive	Nassau Life Insurance Company of Kansas	300667	Agent - Life	10/17/2011	12/13/2012
Inactive	Nassau Life Insurance Company of Texas	300872	Agent - Health	10/17/2011	1/24/2012
Inactive	Nassau Life Insurance Company of Texas	300872	Agent - Life	10/17/2011	1/24/2012
Inactive	PacifiCare Life and Health Insurance Company	301304	Agent - Health	2/12/2007	11/30/2009
Inactive	Provident American Life & Health Insurance Company	300413	Agent - Health	12/5/2006	11/28/2008
Inactive	Provident American Life & Health Insurance Company	300413	Agent - Life	12/5/2006	11/28/2008
Inactive	Shenandoah Life Insurance Company	300130	Agent - Health	3/12/2007	5/27/2007
Inactive	Shenandoah Life Insurance Company	300130	Agent - Life	3/12/2007	5/27/2007
Inactive	United Teacher Associates Insurance Company	300747	Agent - Health	12/5/2006	10/3/2007
Inactive	United Teacher Associates Insurance Company	300747	Agent - Life	2/1/2007	10/3/2007
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	10/3/2011	6/22/2012
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	10/3/2011	6/22/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Agency Development, Inc.	560888	Agent - Health	5/21/2004	9/12/2004
Inactive	Agency Development, Inc.	560888	Agent - Life	5/21/2004	9/12/2004
Inactive	COSTELLOW MANAGEMENT INC	614755	Agent - Health	2/1/2007	11/30/2009
Inactive	COSTELLOW MANAGEMENT INC	614755	Agent - Life	2/1/2007	11/30/2009
Inactive	Heritage Plans, LLC	560425	Agent - Health	5/21/2004	9/12/2004
Inactive	Heritage Plans, LLC	560425	Agent - Life	5/21/2004	9/12/2004