DEPARTMENT OF INSURANCE
Affiliations
NameFundamental Insurance and Retirement PlanningDOIID675147NAIC NPN10310756
License - Line of Authority Information
StatusResidencyClassLine of AuthorityActive DateInactive DateLicense Expiration Date
InactiveNon ResidentAgentLife5/30/20083/31/2018 
InactiveNon ResidentAgentHealth5/30/20083/31/2018 
* 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
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveAetna Health Inc. (PA)660717Agent - Health12/8/20113/31/2018
InactiveAetna Life Insurance Company301140Agent - Health12/8/20113/31/2018
InactiveAetna Life Insurance Company301140Agent - Life12/8/20113/31/2018
InactiveAmerican Continental Insurance Company643130Agent - Health6/28/201011/12/2014
InactiveAmerican Continental Insurance Company643130Agent - Life6/28/201011/12/2014
InactiveAmerican Equity Investment Life Insurance Company300389Agent - Life9/26/20122/19/2016
InactiveAmerican National Life Insurance Company of Texas300912Agent - Health6/13/20082/11/2010
InactiveAmerican National Life Insurance Company of Texas300912Agent - Life6/13/20082/11/2010
InactiveAmerican Pioneer Life Insurance Company301782Agent - Health10/17/20119/13/2012
InactiveAmerican Pioneer Life Insurance Company301782Agent - Life10/17/20119/13/2012
InactiveAnthem Health Plans of Kentucky, Inc.300999Agent - Health12/23/20093/31/2018
InactiveAnthem Insurance Companies, Inc.300941Agent - Health12/23/200910/16/2012
InactiveAnthem Life Insurance Company301209Agent - Health12/23/20093/31/2018
InactiveAnthem Life Insurance Company301209Agent - Life12/23/20093/31/2018
InactiveArcadian Health Plan, Inc.728196Agent - Health10/18/20175/11/2018
InactiveAthene Annuity & Life Assurance Company301798Agent - Life1/3/20138/13/2015
InactiveBaptist Health Plan, Inc.300157Agent - Health9/16/20133/31/2018
InactiveCIGNA Health & Life Insurance Company301783Agent - Health4/29/20143/31/2018
InactiveCIGNA Health & Life Insurance Company301783Agent - Life4/29/20143/31/2018
InactiveCentral States Indemnity Company of Omaha300285Agent - Health12/12/201212/11/2014
InactiveCincinnati Life Insurance Company (The)300601Agent - Health10/6/20105/17/2016
InactiveCincinnati Life Insurance Company (The)300601Agent - Life10/6/20105/17/2016
InactiveCompBenefits Dental, Inc.591692Agent - Health4/2/201012/13/2016
InactiveCompBenefits Insurance Company301864Agent - Health4/2/20107/2/2013
InactiveCompBenefits Insurance Company301864Agent - Life4/2/20107/2/2013
InactiveDental Concern Inc. (The)301641Agent - Health4/2/20105/11/2018
InactiveEquiTrust Life Insurance Company502870Agent - Life5/20/20133/31/2018
InactiveFamily Life Insurance Company300356Agent - Health8/15/201212/28/2012
InactiveFirst Health Life & Health Insurance Company301735Agent - Health8/17/20113/31/2018
InactiveForethought Life Insurance Company301407Agent - Health1/9/201212/20/2016
InactiveForethought Life Insurance Company301407Agent - Life1/9/201212/20/2016
InactiveGerber Life Insurance Company300529Agent - Health5/4/201012/26/2012
InactiveGerber Life Insurance Company300529Agent - Life5/4/201012/26/2012
InactiveGolden Rule Insurance Company301943Agent - Health5/3/20128/10/2017
InactiveGolden Rule Insurance Company301943Agent - Life5/3/20128/10/2017
InactiveGuarantee Trust Life Insurance Company301043Agent - Health1/20/20176/6/2017
InactiveGuarantee Trust Life Insurance Company301043Agent - Life1/20/20176/6/2017
InactiveHumana Health Plan of Ohio Inc.301565Agent - Health1/11/201312/8/2015
InactiveHumana Health Plan, Inc.300142Agent - Health4/2/20105/11/2018
InactiveHumana Insurance Company301104Agent - Health4/2/20105/11/2018
InactiveHumana Insurance Company301104Agent - Life4/2/20105/11/2018
InactiveHumana Insurance Company of Kentucky300826Agent - Health4/2/201012/8/2015
InactiveHumana Insurance Company of Kentucky300826Agent - Life4/2/201012/8/2015
InactiveIndependent Order of Foresters300743Agent - Life2/12/20103/31/2018
InactiveKanawha Insurance Company300127Agent - Life1/11/201310/22/2015
InactiveMarquette National Life Insurance Company300117Agent - Health10/17/20119/13/2012
InactiveMarquette National Life Insurance Company300117Agent - Life10/17/20119/13/2012
InactiveMassMutual Ascend Life Insurance Company300320Agent - Life11/2/201210/17/2014
InactiveMedico Insurance Company301559Agent - Health2/18/20127/13/2016
InactiveMedico Insurance Company301559Agent - Life2/18/20127/13/2016
InactiveMutual of Omaha Insurance Company301012Agent - Health6/16/201012/26/2012
InactiveNassau Life Insurance Company of Kansas300667Agent - Health10/17/20111/6/2014
InactiveNassau Life Insurance Company of Kansas300667Agent - Life10/17/201112/13/2012
InactiveNorth American Company for Life and Health Insurance300291Agent - Life5/20/20139/11/2017
InactiveOmaha Insurance Company751908Agent - Health11/25/201510/24/2016
InactivePHL Variable Insurance Company300525Agent - Life1/15/201311/10/2016
InactiveProvident Life and Accident Insurance Company301525Agent - Health2/6/20139/9/2015
InactiveProvident Life and Accident Insurance Company301525Agent - Life2/6/20139/9/2015
InactiveStandard Life and Accident Insurance Company301534Agent - Health6/18/20082/11/2010
InactiveStandard Life and Accident Insurance Company301534Agent - Life6/18/20082/11/2010
InactiveTime Insurance Company300683Agent - Health1/22/201312/20/2014
InactiveTime Insurance Company300683Agent - Life1/22/201312/20/2014
InactiveUNUM Life Insurance Company of America300817Agent - Health2/6/20139/9/2015
InactiveUNUM Life Insurance Company of America300817Agent - Life2/6/20139/9/2015
InactiveUnited of Omaha Life Insurance Company300156Agent - Health6/16/201012/26/2012
InactiveUnited of Omaha Life Insurance Company300156Agent - Life6/16/201012/26/2012
InactiveUnitedHealthcare Insurance Company300946Agent - Health12/31/200911/9/2017
InactiveUnitedHealthcare Insurance Company300946Agent - Life12/31/20093/31/2018
InactiveUnitedHealthcare Insurance Company of America301552Agent - Health9/11/201611/9/2017
InactiveUnitedHealthcare of Kentucky, Ltd.301337Agent - Health12/31/200912/1/2016
InactiveUnitedHealthcare of Ohio, Inc.300493Agent - Health12/31/200912/1/2016
InactiveUnitedHealthcare of Wisconsin, Inc.871491Agent - Health9/11/201511/9/2017
Designated Individuals
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveBrychell, Christopher Stephen 674783Agent - Health5/30/20086/24/2013
InactiveBrychell, Christopher Stephen 674783Agent - Life5/30/200812/26/2012
InactiveBuck, Justin Michael 757286Agent - Health7/23/20124/30/2013
InactiveBuck, Justin Michael 757286Agent - Life7/23/20124/30/2013
InactiveBuck, Michael Dean 727741Agent - Health8/3/201212/31/2013
InactiveBuck, Michael Dean 727741Agent - Life8/3/201212/31/2013
InactiveChase, David Michael 760181Agent - Health9/20/20113/31/2018
InactiveChase, David Michael 760181Agent - Life9/20/20113/31/2018
InactiveCurley, James M 391545Agent - Health9/8/20113/31/2018
InactiveCurley, James M 391545Agent - Life9/8/20113/31/2018
InactiveFreyler, Douglas Robert 372145Agent - Health1/11/20109/1/2011
InactiveFreyler, Douglas Robert 372145Agent - Life1/11/20109/1/2011
InactiveFurnish, David Joseph 718646Agent - Health5/20/201111/4/2011
InactiveFurnish, David Joseph 718646Agent - Life5/20/201111/4/2011
InactiveGeorge, Brian 714505Agent - Health5/20/20113/31/2018
InactiveGeorge, Brian 714505Agent - Life5/20/20113/31/2018
InactiveHalbrook, Michael Dale 664559Agent - Health1/27/201210/31/2016
InactiveHalbrook, Michael Dale 664559Agent - Life1/27/201210/31/2016
InactiveHamlin, Jeffrey V 728011Agent - Health8/14/20123/31/2018
InactiveHamlin, Jeffrey V 728011Agent - Life8/14/20123/31/2018
InactiveHazelbaker, Richard Keith 384277Agent - Health10/10/20113/31/2018
InactiveHazelbaker, Richard Keith 384277Agent - Life10/10/20113/31/2018
InactiveHollingsworth, Emily A 787894Agent - Health8/30/20125/31/2016
InactiveHollingsworth, Emily A 787894Agent - Life8/30/20125/31/2016
InactiveJohnson, Jeffrey Scott 325955Agent - Health9/21/20113/31/2018
InactiveJohnson, Jeffrey Scott 325955Agent - Life9/21/20113/31/2018
DeniedJones, Jeremy A 510871Agent - Health  
DeniedJones, Jeremy A 510871Agent - Life  
InactiveLedbetter, Shannon Bruce 329947Agent - Health9/21/20112/3/2017
InactiveLedbetter, Shannon Bruce 329947Agent - Life9/21/20112/3/2017
InactiveLykins, Kevin Clay 705841Agent - Health11/22/201111/3/2016
InactiveLykins, Kevin Clay 705841Agent - Life11/22/201111/3/2016
InactiveMaki, Randy 723065Agent - Health12/15/201112/1/2012
InactiveMaki, Randy 723065Agent - Life12/15/201112/1/2012
InactiveMoran, Thomas Leighton 919806Agent - Health6/28/20162/7/2018
DeniedMoran, Thomas Leighton 919806Agent - Life  
InactiveMotsinger, John O 393079Agent - Health10/23/20123/31/2018
InactiveMotsinger, John O 393079Agent - Life10/23/20123/31/2018
InactiveMurrow, Daniel Thomas 626370Agent - Health10/21/20113/31/2018
InactiveMurrow, Daniel Thomas 626370Agent - Life10/21/20113/31/2018
InactivePeace, Erica Lee 589466Agent - Health1/11/201012/7/2012
InactivePeace, Erica Lee 589466Agent - Life1/11/201012/7/2012
InactiveRoark, Elizabeth W 366892Agent - Health9/8/20113/31/2018
InactiveRoark, Elizabeth W 366892Agent - Life9/8/20113/31/2018
InactiveSaleh, Sayed Mohammad 348856Agent - Health12/23/20093/31/2018
InactiveSaleh, Sayed Mohammad 348856Agent - Life12/23/20093/31/2018
InactiveSpainhour, Jeffrey Dennis 340181Agent - Health10/11/20123/31/2018
InactiveSpainhour, Jeffrey Dennis 340181Agent - Life10/11/20123/31/2018
InactiveWeeks, Dustin A 345068Agent - Health5/20/201110/5/2011
InactiveWeeks, Dustin A 345068Agent - Life5/20/201110/5/2011
InactiveWiesemann, Michael Wayne 629185Agent - Health12/23/20095/31/2016
InactiveWiesemann, Michael Wayne 629185Agent - Life12/23/20095/31/2016
InactiveWilliams, Richard Granton 388047Agent - Health9/29/20113/31/2018
InactiveWilliams, Richard Granton 388047Agent - Life9/29/20113/31/2018
InactiveWoodward, Lauren 755419Agent - Health1/18/20123/31/2018
InactiveWoodward, Lauren 755419Agent - Life1/10/20123/31/2018
InactiveWoznicki, Eugene 534021Agent - Health9/8/20113/31/2018
InactiveWoznicki, Eugene 534021Agent - Life9/8/20113/31/2018

© Commonwealth of Kentucky. All rights reserved.