DEPARTMENT OF INSURANCE

Affiliations

Name	Burgoon, Roy M	DOIID	698063	NAIC NPN	1791902

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Health	1/27/2009	10/31/2014
Inactive	Non Resident	Agent	Life	1/27/2009	10/31/2014
* 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	Aetna Health Inc. (PA)	660717	Agent - Health	3/13/2009	10/31/2014
Inactive	Aetna Life Insurance Company	301140	Agent - Health	3/13/2009	10/31/2014
Inactive	Aetna Life Insurance Company	301140	Agent - Life	3/13/2009	10/31/2014
Inactive	American Continental Insurance Company	643130	Agent - Health	9/4/2009	11/12/2014
Inactive	American Continental Insurance Company	643130	Agent - Life	9/4/2009	11/12/2014
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	8/24/2011	8/20/2012
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	9/4/2009	10/31/2014
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Life	9/4/2009	10/31/2014
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	8/24/2011	8/20/2012
Inactive	Gerber Life Insurance Company	300529	Agent - Health	3/23/2010	12/26/2012
Inactive	Gerber Life Insurance Company	300529	Agent - Life	3/23/2010	12/26/2012
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	8/24/2011	8/20/2012
Inactive	Humana Insurance Company	301104	Agent - Health	8/24/2011	8/20/2012
Inactive	Humana Insurance Company	301104	Agent - Life	8/24/2011	8/20/2012
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	8/24/2011	8/20/2012
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	8/24/2011	8/20/2012
Inactive	Kanawha Insurance Company	300127	Agent - Health	8/24/2011	8/20/2012
Inactive	Kanawha Insurance Company	300127	Agent - Life	8/24/2011	8/20/2012
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	4/14/2010	10/31/2014
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	4/14/2010	10/31/2014

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Cardinal Brokerage Ins Agcy Inc	713665	Agent - Health	9/17/2009	3/31/2013
Inactive	Cardinal Brokerage Ins Agcy Inc	713665	Agent - Life	9/17/2009	3/31/2013
Inactive	Talus Brokerage Services LLC	701952	Agent - Health	8/24/2009	3/31/2013
Inactive	Talus Brokerage Services LLC	701952	Agent - Life	8/24/2009	3/31/2013