DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Fortin, William	DOIID	701128	NAIC NPN	2431993

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	3/16/2009		12/31/2026
Active	Non Resident	Agent	Life	3/16/2009		12/31/2026
Active	Non Resident	Life & Health Consultant	Not Applicable	3/30/2012		12/31/2026
* 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	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	3/8/2020	12/16/2024
Active	CIGNA Dental Health of Kentucky, Inc.	300904	Agent - Health	1/5/2015
Active	CIGNA Health & Life Insurance Company	301783	Agent - Health	12/4/2014
Active	CIGNA Health & Life Insurance Company	301783	Agent - Life	12/4/2014
Active	Hartford Life and Accident Insurance Company	300878	Agent - Health	5/27/2015
Active	Hartford Life and Accident Insurance Company	300878	Agent - Life	5/27/2015
Active	Provident Life and Accident Insurance Company	301525	Agent - Health	12/20/2023
Active	Provident Life and Accident Insurance Company	301525	Agent - Life	12/20/2023
Active	Starmount Life Insurance Company	628031	Agent - Health	12/20/2023
Active	UNUM Life Insurance Company of America	300817	Agent - Health	12/20/2023
Active	UNUM Life Insurance Company of America	300817	Agent - Life	12/20/2023
Active	UnitedHealthcare Insurance Company	300946	Agent - Health	6/10/2010
Active	UnitedHealthcare Insurance Company	300946	Agent - Life	6/10/2010
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	6/10/2010	12/1/2016
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	6/10/2010	12/1/2016
Active	Unum Insurance Company	301499	Agent - Health	12/20/2023
Active	Unum Insurance Company	301499	Agent - Life	12/20/2023
Active	Vision Service Plan Insurance Company	300526	Agent - Health	10/5/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Designated Agent Company Inc.	681257	Agent - Health	3/10/2020	2/10/2025
Inactive	Designated Agent Company Inc.	681257	Agent - Life	3/10/2020	2/10/2025
Active	Mercer Health & Benefits LLC	607080	Agent - Health	4/5/2012
Active	Mercer Health & Benefits LLC	607080	Agent - Life	4/5/2012
Active	Mercer Health & Benefits LLC	607080	Life & Health Consultant - Not Applicable	4/5/2012