DEPARTMENT OF INSURANCE

Affiliations

Name	Fortner, Terry Gene	DOIID	587713	NAIC NPN	8043019

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Resident	Agent	Health	4/21/2004	7/31/2024
Active	Resident	Agent	Life	4/22/2004	7/31/2024
Denied	Resident	Agent	Property
Denied	Resident	Agent	Casualty
* 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	05/15/2024	07/31/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Acacia Life Insurance Company	300375	Agent - Health	12/8/2008	4/1/2011
Inactive	Acacia Life Insurance Company	300375	Agent - Life	12/8/2008	4/1/2011
Inactive	American Continental Insurance Company	643130	Agent - Health	11/8/2012	6/6/2016
Inactive	American Continental Insurance Company	643130	Agent - Life	11/8/2012	12/15/2020
Active	American General Life Insurance Company	301585	Agent - Health	6/12/2017
Active	American General Life Insurance Company	301585	Agent - Life	6/12/2017
Inactive	American General Life and Accident Insurance Company	301362	Agent - Health	4/21/2004	1/21/2005
Inactive	American General Life and Accident Insurance Company	301362	Agent - Life	4/22/2004	1/21/2005
Inactive	American Memorial Life Insurance Company	301445	Agent - Life	4/7/2018	5/21/2019
Inactive	American Retirement Life Insurance Company	706303	Agent - Health	1/2/2014	12/28/2015
Inactive	American Retirement Life Insurance Company	706303	Agent - Life	1/2/2014	12/28/2015
Inactive	Americo Financial Life and Annuity Insurance Company	300869	Agent - Life	8/8/2018	6/7/2022
Inactive	Ameritas Life Insurance Corporation	300126	Agent - Health	12/31/2016	10/26/2021
Inactive	Ameritas Life Insurance Corporation	300126	Agent - Life	12/31/2016	10/26/2021
Inactive	Athene Annuity & Life Assurance Company of New York	300724	Agent - Life	11/19/2007	5/8/2013
Inactive	Athene Annuity and Life Company	301893	Agent - Life	3/11/2011	11/29/2021
Inactive	Baltimore Life Insurance Company	300286	Agent - Life	5/7/2013	10/17/2015
Active	CIGNA Health & Life Insurance Company	301783	Agent - Health	1/9/2014
Active	CIGNA Health & Life Insurance Company	301783	Agent - Life	1/9/2014
Active	Colonial Life and Accident Insurance Company	300846	Agent - Health	1/6/2009
Active	Colonial Life and Accident Insurance Company	300846	Agent - Life	1/6/2009
Inactive	Columbian Life Insurance Company	300810	Agent - Life	3/24/2009	6/18/2019
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	2/28/2014	8/14/2015
Inactive	Connecticut General Life Insurance Company	301333	Agent - Health	2/17/2011	6/11/2014
Inactive	Connecticut General Life Insurance Company	301333	Agent - Life	2/17/2011	6/11/2014
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	2/28/2014	8/14/2015
Inactive	EquiTrust Life Insurance Company	502870	Agent - Life	5/24/2013	7/16/2015
Inactive	Everly Life Insurance Company	561641	Agent - Life	1/2/2014	3/7/2017
Inactive	Fidelity & Guaranty Life Insurance Company	301359	Agent - Life	2/28/2012	11/13/2015
Inactive	Fidelity Life Association, A Legal Reserve Life Insurance Company	300774	Agent - Life	3/5/2009	7/26/2016
Inactive	Forethought Life Insurance Company	301407	Agent - Health	8/9/2011	10/30/2014
Active	Forethought Life Insurance Company	301407	Agent - Life	3/10/2021
Inactive	Genworth Life and Annuity Insurance Company	301276	Agent - Health	12/20/2008	12/7/2012
Inactive	Genworth Life and Annuity Insurance Company	301276	Agent - Life	12/20/2008	12/7/2012
Inactive	Gerber Life Insurance Company	300529	Agent - Health	4/25/2016	2/7/2019
Inactive	Gerber Life Insurance Company	300529	Agent - Life	4/25/2016	2/7/2019
Inactive	Golden Rule Insurance Company	301943	Agent - Health	11/10/2005	6/9/2008
Inactive	Golden Rule Insurance Company	301943	Agent - Life	11/10/2005	6/9/2008
Inactive	Guarantee Trust Life Insurance Company	301043	Agent - Health	7/26/2011	3/23/2016
Inactive	Guarantee Trust Life Insurance Company	301043	Agent - Life	7/26/2011	3/23/2016
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	2/28/2014	8/14/2015
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	2/28/2014	8/14/2015
Inactive	Humana Insurance Company	301104	Agent - Health	2/28/2014	8/14/2015
Inactive	Humana Insurance Company	301104	Agent - Life	2/28/2014	8/14/2015
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	2/28/2014	8/14/2015
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	2/28/2014	8/14/2015
Inactive	Illinois Mutual Life Insurance Company	301479	Agent - Health	5/12/2010	11/12/2012
Inactive	Illinois Mutual Life Insurance Company	301479	Agent - Life	5/12/2010	11/12/2012
Denied	Independent Mutual Fire Insurance Company	300851	Agent - Casualty
Denied	Independent Mutual Fire Insurance Company	300851	Agent - Property
Inactive	Independent Order of Foresters	300743	Agent - Life	3/25/2010	12/19/2014
Inactive	John Alden Life Insurance Company	300573	Agent - Health	1/7/2009	12/29/2010
Inactive	John Alden Life Insurance Company	300573	Agent - Life	1/7/2009	12/29/2010
Inactive	Kanawha Insurance Company	300127	Agent - Health	2/28/2014	8/14/2015
Inactive	Kanawha Insurance Company	300127	Agent - Life	2/28/2014	8/14/2015
Active	Liberty Bankers Life Insurance Company	542461	Agent - Life	12/16/2015
Inactive	Medico Corp Life Insurance Company	301777	Agent - Health	5/19/2016	12/21/2016
Inactive	Medico Corp Life Insurance Company	301777	Agent - Life	5/19/2016	12/21/2016
Inactive	Medico Insurance Company	301559	Agent - Health	11/11/2016	12/26/2018
Inactive	Medico Insurance Company	301559	Agent - Life	11/11/2016	12/26/2018
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	6/16/2012	6/24/2013
Inactive	Nassau Life Insurance Company of Texas	300872	Agent - Health	10/28/2009	9/13/2012
Inactive	Nassau Life Insurance Company of Texas	300872	Agent - Life	10/28/2009	9/13/2012
Inactive	North American Company for Life and Health Insurance	300291	Agent - Health	4/30/2013	9/29/2015
Inactive	North American Company for Life and Health Insurance	300291	Agent - Life	4/30/2013	9/29/2015
Inactive	Occidental Life Insurance Company of North Carolina	301185	Agent - Life	3/27/2017	8/7/2018
Inactive	Omaha Insurance Company	751908	Agent - Health	4/11/2017	2/22/2018
Active	Physicians Life Insurance Company	300924	Agent - Life	12/27/2023
Active	Renaissance Life & Health Insurance Company of America	301447	Agent - Health	6/24/2015
Inactive	Royal Neighbors of America	301646	Agent - Life	3/27/2013	10/21/2015
Inactive	S.USA Life Insurance Company, Inc.	301774	Agent - Life	1/22/2018	6/24/2019
Inactive	SILAC Insurance Company	300535	Agent - Health	3/22/2011	11/10/2020
Inactive	SILAC Insurance Company	300535	Agent - Life	3/22/2011	11/10/2020
Inactive	Security Life Insurance Company of America	300936	Agent - Health	7/16/2015	12/31/2016
Inactive	Security Life Insurance Company of America	300936	Agent - Life	7/16/2015	12/31/2016
Inactive	Security National Life Insurance Company	569786	Agent - Life	5/22/2014	8/1/2018
Inactive	Sterling Life Insurance Company	301947	Agent - Health	10/5/2011	11/30/2012
Inactive	Stonebridge Life Insurance Company	301614	Agent - Health	1/16/2015	10/1/2015
Inactive	Stonebridge Life Insurance Company	301614	Agent - Life	1/16/2015	10/1/2015
Inactive	Time Insurance Company	300683	Agent - Health	3/10/2015	11/25/2019
Inactive	Time Insurance Company	300683	Agent - Life	3/10/2015	11/25/2019
Inactive	Transamerica Life Insurance Company	300571	Agent - Health	10/1/2015	6/26/2017
Inactive	Transamerica Life Insurance Company	300571	Agent - Life	10/1/2015	6/26/2017
Inactive	Transamerica Premier Life Insurance Company	300558	Agent - Health	6/23/2017	11/12/2018
Inactive	Transamerica Premier Life Insurance Company	300558	Agent - Life	6/23/2017	11/12/2018
Inactive	Trinity Life Insurance Company	552459	Agent - Life	4/11/2016	5/4/2017
Inactive	Union Central Life Insurance Company	300307	Agent - Health	12/8/2008	12/31/2012
Inactive	Union Central Life Insurance Company	300307	Agent - Life	12/8/2008	12/31/2012
Inactive	United American Insurance Company	300910	Agent - Life	5/13/2016	2/25/2019
Inactive	United World Life Insurance Company	300532	Agent - Health	7/12/2005	11/9/2010
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	3/17/2011	12/26/2012
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	3/17/2011	12/26/2012
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	9/27/2011	3/9/2016
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	9/27/2011	3/9/2016
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	9/12/2015	3/9/2016
Inactive	Wysh Life and Health Insurance Company	779030	Agent - Health	10/26/2012	3/31/2015

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Barnett-Strother Funeral Home LLC	748555	Agent - Life	11/8/2022	3/31/2023
Active	Cornerstone Senior Services LLC	399590	Agent - Health	3/15/2011
Active	Cornerstone Senior Services LLC	399590	Agent - Life	3/15/2011
Inactive	Designated Agent Company Inc.	681257	Agent - Health	12/11/2013	4/20/2016
Inactive	Designated Agent Company Inc.	681257	Agent - Life	12/11/2013	4/20/2016
Inactive	Medlink Inc	400721	Agent - Health	1/6/2009	3/31/2024
Inactive	Medlink Inc	400721	Agent - Life	1/6/2009	3/31/2024