DEPARTMENT OF INSURANCE

Affiliations

Name	Petit Homme, Serge	DOIID	737092	NAIC NPN	15823628

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Life	8/4/2011	1/31/2024
Inactive	Non Resident	Agent	Health	9/15/2010	1/31/2024
* 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	AXIS Insurance Company	301290	Agent - Health	7/23/2021	10/18/2023
Inactive	Accendo Insurance Company	300312	Agent - Life	8/19/2021	1/31/2024
Inactive	Aetna Health Inc. (PA)	660717	Agent - Health	7/27/2022	1/31/2024
Inactive	Aetna Health and Life Insurance Company	300523	Agent - Health	8/19/2021	1/31/2024
Inactive	Aetna Health of Ohio Inc.	1065035	Agent - Health	7/27/2022	1/31/2024
Inactive	Aetna Life Insurance Company	301140	Agent - Health	7/27/2022	1/31/2024
Inactive	American Financial Security Life Insurance Co.	301635	Agent - Health	11/2/2012	1/31/2024
Inactive	American Financial Security Life Insurance Co.	301635	Agent - Life	11/2/2012	1/31/2024
Inactive	American General Life Insurance Company	301585	Agent - Health	7/7/2021	6/8/2022
Inactive	American General Life Insurance Company	301585	Agent - Life	7/7/2021	6/8/2022
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	7/19/2021	1/31/2024
Inactive	Anthem Life Insurance Company	301209	Agent - Health	11/24/2014	1/31/2024
Inactive	Anthem Life Insurance Company	301209	Agent - Life	11/24/2014	1/31/2024
Inactive	Athene Annuity & Life Assurance Company of New York	300724	Agent - Health	8/1/2011	10/16/2011
Inactive	Care Improvement Plus South Central Insurance Company	799697	Agent - Health	7/17/2022	12/12/2023
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	7/19/2011	12/4/2013
Inactive	Companion Life Insurance Company	300191	Agent - Health	8/3/2011	3/8/2018
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	8/19/2021	1/31/2024
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Life	8/19/2021	1/31/2024
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	11/18/2014	5/28/2015
Inactive	Family Life Insurance Company	300356	Agent - Health	6/18/2014	8/19/2016
Inactive	Family Life Insurance Company	300356	Agent - Life	6/18/2014	8/19/2016
Inactive	Gerber Life Insurance Company	300529	Agent - Health	11/18/2015	2/9/2018
Inactive	Gerber Life Insurance Company	300529	Agent - Life	11/18/2015	2/9/2018
Inactive	Golden Rule Insurance Company	301943	Agent - Health	11/10/2022	2/2/2024
Inactive	Golden Rule Insurance Company	301943	Agent - Life	11/10/2022	2/2/2024
Inactive	HCC Life Insurance Company	301827	Agent - Health	3/26/2015	5/16/2017
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	11/18/2014	5/28/2015
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	11/18/2014	5/28/2015
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	11/18/2014	5/28/2015
Inactive	Humana Insurance Company	301104	Agent - Health	11/18/2014	5/28/2015
Inactive	Humana Insurance Company	301104	Agent - Life	11/18/2014	5/28/2015
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	11/18/2014	5/28/2015
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	11/18/2014	5/28/2015
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	11/18/2014	5/28/2015
Inactive	Independence American Insurance Company	524747	Agent - Health	6/26/2017	12/11/2019
Inactive	Kanawha Insurance Company	300127	Agent - Health	7/19/2011	12/4/2013
Inactive	LifeShield National Insurance Company	737111	Agent - Health	2/24/2017	1/19/2023
Inactive	LifeShield National Insurance Company	737111	Agent - Life	2/24/2017	1/19/2023
Inactive	Madison National Life Insurance Company Inc.	301458	Agent - Health	11/2/2015	12/17/2019
Inactive	Madison National Life Insurance Company Inc.	301458	Agent - Life	11/2/2015	12/17/2019
Inactive	PHL Variable Insurance Company	300525	Agent - Life	1/2/2016	12/14/2018
Inactive	SilverScript Insurance Company	663526	Agent - Health	7/27/2022	1/31/2024
Inactive	Southern Guaranty Insurance Company	969411	Agent - Health	9/26/2018	9/30/2021
Inactive	Time Insurance Company	300683	Agent - Health	9/20/2011	10/25/2016
Inactive	Time Insurance Company	300683	Agent - Life	9/20/2011	10/25/2016
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	7/15/2022	12/12/2023
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	7/15/2022	12/22/2022
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	7/15/2022	12/12/2023

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	11/24/2014	1/31/2024
Inactive	Designated Agent Company Inc.	681257	Agent - Life	11/24/2014	1/31/2024
Inactive	Health Plan Intermediaries Holdings	786463	Agent - Health	8/6/2021	8/16/2022
Inactive	Ican Benefit Group, LLC	663794	Agent - Health	8/8/2016	3/31/2023
Inactive	Ican Benefit Group, LLC	663794	Agent - Life	8/8/2016	3/31/2023