DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Dieterich, Tracy Lee	DOIID	704283	NAIC NPN	1151798

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	4/21/2009		11/30/2024
Active	Non Resident	Agent	Life	4/21/2009		11/30/2024
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	09/15/2024	11/30/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Berkshire Hathaway Specialty Insurance Company	300908	Agent - Health	11/12/2019
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Health	1/28/2013	10/12/2020
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Life	1/28/2013	10/12/2020
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	7/17/2013	12/8/2015
Active	Guardian Life Insurance Company of America	301316	Agent - Health	1/28/2013
Active	Guardian Life Insurance Company of America	301316	Agent - Life	1/28/2013
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	7/17/2013	12/8/2015
Inactive	Humana Insurance Company	301104	Agent - Health	7/17/2013	12/8/2015
Inactive	Humana Insurance Company	301104	Agent - Life	7/17/2013	12/8/2015
Inactive	Kanawha Insurance Company	300127	Agent - Health	7/17/2013	10/22/2015
Inactive	Kanawha Insurance Company	300127	Agent - Life	7/17/2013	10/22/2015

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	USI Insurance Services National, Inc	509421	Agent - Life	2/7/2013	10/9/2019
Inactive	USI Insurance Services National, Inc	509421	Agent - Health	2/7/2013	10/9/2019
Active	Usi Insurance Services LLC	669260	Agent - Life	12/27/2018
Active	Usi Insurance Services LLC	669260	Agent - Health	12/27/2018
Denied	Wells Fargo Insurance Services of Texas Inc	505616	Agent - Life
Denied	Wells Fargo Insurance Services of Texas Inc	505616	Agent - Health