PUBLIC PROTECTION
CABINET
DEPARTMENT OF INSURANCE
Affiliations
NameVan Brocklin, David EDOIID743505NAIC NPN460816
License - Line of Authority Information
StatusResidencyClassLine of AuthorityActive DateInactive DateLicense Expiration Date
Pending ReplacementNon ResidentAgentLife8/15/2020 5/31/2025
Pending ReplacementNon ResidentAgentHealth8/15/2020 5/31/2025
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.
License Renewal Information
ClassInvoice DateResponse Due / Expiration DateResponse Received DatePayment Received DateRenewal Complete
Agent03/15/202505/31/2025   
Appointments with the following Insurers
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveAmerican Financial Security Life Insurance Co.301635Agent - Health11/2/20125/14/2015
InactiveAmerican Financial Security Life Insurance Co.301635Agent - Life11/2/20125/14/2015
DeniedAmerican General Life Insurance Company301585Agent - Health  
DeniedAmerican General Life Insurance Company301585Agent - Life  
Pending ReplacementAnthem Health Plans of Kentucky, Inc.300999Agent - Health2/17/2021 
InactiveAnthem Life Insurance Company301209Agent - Health2/17/20214/15/2025
InactiveAnthem Life Insurance Company301209Agent - Life2/17/20214/15/2025
InactiveCareSource Kentucky Co.838179Agent - Health12/2/20212/3/2023
InactiveCompanion Life Insurance Company300191Agent - Health2/16/201210/13/2014
InactiveFamily Life Insurance Company300356Agent - Health6/18/20145/14/2015
InactiveFamily Life Insurance Company300356Agent - Life6/18/20145/14/2015
DeniedFreedom Life Insurance Company of America300074Agent - Health  
DeniedFreedom Life Insurance Company of America300074Agent - Life  
InactiveGolden Rule Insurance Company301943Agent - Health2/8/20236/3/2025
InactiveGolden Rule Insurance Company301943Agent - Life2/8/20236/3/2025
InactiveHumana Health Plan of Ohio Inc.301565Agent - Health10/23/20135/20/2014
InactiveHumana Health Plan, Inc.300142Agent - Health10/23/20135/20/2014
InactiveHumana Insurance Company301104Agent - Health10/23/20135/20/2014
InactiveHumana Insurance Company301104Agent - Life10/23/20135/20/2014
InactiveHumana Insurance Company of Kentucky300826Agent - Health10/23/20135/20/2014
InactiveHumana Insurance Company of Kentucky300826Agent - Life10/23/20135/20/2014
InactiveIndependent Order of Foresters300743Agent - Life4/20/20115/14/2015
InactiveMadison National Life Insurance Company Inc.301458Agent - Life2/22/20116/19/2012
InactiveMolina Healthcare of Kentucky, Inc.1035856Agent - Health11/8/20215/7/2025
InactivePioneer American Insurance Company301268Agent - Life12/9/20109/28/2011
InactiveTime Insurance Company300683Agent - Health3/1/201210/21/2014
InactiveTime Insurance Company300683Agent - Life3/1/201210/21/2014
InactiveWellCare Health Plans of Kentucky, Inc.838592Agent - Health1/11/202212/22/2022
Designated to act on behalf of the following Business Entities
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveAssurance IQ, LLC919554Agent - Life3/28/20235/15/2024
InactiveAssurance IQ, LLC919554Agent - Health3/28/20235/15/2024

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