DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Fahlman, Jeffrey T	DOIID	739501	NAIC NPN	2760557

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	10/12/2010	9/30/2012
* 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	CompBenefits Dental, Inc.	591692	Agent - Health	11/2/2010	3/17/2011
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	11/2/2010	3/17/2011
Inactive	Humana Insurance Company	301104	Agent - Health	11/2/2010	3/17/2011
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	11/2/2010	3/17/2011

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	PNC Insurance Services LLC	400874	Agent - Health