DEPARTMENT OF INSURANCE

Affiliations

Name	Peterson, Derek	DOIID	703115	NAIC NPN	7552899

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Life	4/3/2009	9/30/2024
Active	Non Resident	Agent	Variable Life and Variable Annuities	4/3/2009	9/30/2024
Active	Non Resident	Agent	Health	4/3/2009	9/30/2024
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Notice: The Department verifies, at the time of application for a Variable Life and Variable Annuity line of authority, that an agent is registered with the Financial Industry Regulatory Authority (FINRA) and the applicant has passed the Series 6 or greater exam. The Department does not verify registration with FINRA after the agent is qualified by the Department to receive the Variable Life and Variable Annuity line of authority. If you have questions about a broker’s FINRA registration status, you should check this status directly with FINRA.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	07/15/2024	09/30/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	10/12/2012	12/10/2012
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	10/12/2012	12/10/2012
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	10/12/2012	1/17/2014
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	10/12/2012	12/10/2012
Inactive	Humana Insurance Company	301104	Agent - Health	10/12/2012	1/17/2014
Inactive	Humana Insurance Company	301104	Agent - Life	10/12/2012	1/17/2014
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	10/12/2012	1/17/2014
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	10/12/2012	1/17/2014
Active	Thrivent Financial for Lutherans	301101	Agent - Health	4/9/2009
Active	Thrivent Financial for Lutherans	301101	Agent - Life	4/9/2009
Active	Thrivent Financial for Lutherans	301101	Agent - Variable Life and Variable Annuities	4/9/2009

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date
Active	Thrivent Ins Agency Inc	510973	Agent - Health	4/28/2009
Active	Thrivent Ins Agency Inc	510973	Agent - Life	4/28/2009
Active	Thrivent Ins Agency Inc	510973	Agent - Variable Life and Variable Annuities	4/28/2009