DEPARTMENT OF INSURANCE

Affiliations

Name	Kuussalo, Shelley Bernard	DOIID	581721	NAIC NPN	7951078

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Life	4/13/2004	11/1/2017
Inactive	Resident	Agent	Health	3/23/2004	11/1/2017
* 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 United Life Insurance Company	300498	Agent - Health	4/24/2008	3/26/2010
Inactive	American United Life Insurance Company	300498	Agent - Life	4/24/2008	3/26/2010
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	7/9/2010	12/5/2014
Inactive	CompBenefits Insurance Company	301864	Agent - Health	7/13/2012	7/2/2013
Inactive	CompBenefits Insurance Company	301864	Agent - Life	7/13/2012	7/2/2013
Inactive	Dental Care Plus Inc.	301495	Agent - Health	4/15/2007	11/1/2017
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	3/21/2009	12/5/2014
Inactive	Encova Life Insurance Company	301818	Agent - Life	9/24/2007	9/21/2011
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Health	5/9/2007	11/1/2017
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Life	5/9/2007	11/1/2017
Inactive	Guardian Insurance & Annuity Company Inc. (The)	301920	Agent - Life	12/10/2008	12/28/2017
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	10/6/2014	12/8/2015
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	6/24/2004	8/11/2016
Inactive	Humana Insurance Company	301104	Agent - Health	6/24/2004	8/11/2016
Inactive	Humana Insurance Company	301104	Agent - Life	6/24/2004	8/11/2016
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	6/24/2004	12/5/2014
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	6/24/2004	12/5/2014
Inactive	HumanaDental Insurance Company	301457	Agent - Health	7/13/2012	12/19/2012
Inactive	HumanaDental Insurance Company	301457	Agent - Life	7/13/2012	12/19/2012
Inactive	Kanawha Insurance Company	300127	Agent - Health	1/10/2011	12/5/2014
Inactive	Kanawha Insurance Company	300127	Agent - Life	1/10/2011	12/5/2014
Inactive	Metropolitan Life Insurance Company	301948	Agent - Health	3/13/2008	12/18/2012
Inactive	Metropolitan Life Insurance Company	301948	Agent - Life	3/13/2008	12/18/2012
Inactive	Principal Life Insurance Company	300129	Agent - Health	4/11/2007	11/1/2017
Inactive	Principal Life Insurance Company	300129	Agent - Life	4/11/2007	11/1/2017
Inactive	Standard Insurance Company	300185	Agent - Health	3/23/2007	11/1/2017
Inactive	Standard Insurance Company	300185	Agent - Life	3/23/2007	11/1/2017
Inactive	Sun Life Assurance Company of Canada	301811	Agent - Health	6/21/2009	4/1/2010
Inactive	Sun Life Assurance Company of Canada	301811	Agent - Life	6/21/2009	4/1/2010
Inactive	Sun Life and Health Insurance Company (U.S.)	300801	Agent - Health	6/13/2007	4/1/2010
Inactive	Sun Life and Health Insurance Company (U.S.)	300801	Agent - Life	6/13/2007	4/1/2010
Inactive	Superior Dental Care Inc.	300418	Agent - Health	12/28/2009	11/1/2017
Inactive	Unimerica Insurance Company	563724	Agent - Health	4/25/2008	12/15/2009
Inactive	Unimerica Insurance Company	563724	Agent - Life	4/25/2008	12/15/2009
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	4/25/2008	12/15/2009
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	4/25/2008	12/15/2009
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	4/25/2008	12/15/2009
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	4/25/2008	12/15/2009

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Ansac Inc.	398408	Agent - Health	1/23/2007	11/1/2017
Inactive	Ansac Inc.	398408	Agent - Life	1/23/2007	11/1/2017
Inactive	Dental Choice Agency Inc.	398085	Agent - Health	5/4/2007	11/8/2013
Inactive	Designated Agent Company Inc.	681257	Agent - Health	12/2/2013	11/1/2017
Inactive	Designated Agent Company Inc.	681257	Agent - Life	12/2/2013	11/1/2017
Inactive	Schwartz & Assoc Inc	400988	Agent - Health	4/19/2010	11/1/2017
Inactive	Schwartz & Assoc Inc	400988	Agent - Life	4/19/2010	11/1/2017