DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Wielgos, Wayne Robert	DOIID	662884	NAIC NPN	1876661

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	8/29/2007	7/31/2009
Inactive	Non Resident	Agent	Health	8/29/2007	7/31/2009
* 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	Dental Concern Inc. (The)	301641	Agent - Health	3/21/2009	7/31/2009
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	3/20/2009	7/31/2009
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	4/10/2008	7/31/2009
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	4/10/2008	7/31/2009
Inactive	HumanaDental Insurance Company	301457	Agent - Health	4/10/2008	7/31/2009
Inactive	HumanaDental Insurance Company	301457	Agent - Life	4/10/2008	7/31/2009
Inactive	Marquette National Life Insurance Company	300117	Agent - Health	5/19/2008	7/3/2008
Inactive	Marquette National Life Insurance Company	300117	Agent - Life	5/19/2008	7/3/2008
Inactive	Standard Security Life Insurance Company of NY	301487	Agent - Health	3/27/2008	7/31/2009
Inactive	Standard Security Life Insurance Company of NY	301487	Agent - Life	3/27/2008	7/31/2009

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Bloom Insurance Agency LLC	664017	Agent - Health	4/1/2008	9/25/2008
Inactive	Bloom Insurance Agency LLC	664017	Agent - Life	4/1/2008	9/25/2008