DEPARTMENT OF INSURANCE

Affiliations

Name	Van Brocklin, David E	DOIID	743505	NAIC NPN	460816

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Health	8/15/2020	5/31/2025
Active	Non Resident	Agent	Life	8/15/2020	5/31/2025
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	American Financial Security Life Insurance Co.	301635	Agent - Health	11/2/2012	5/14/2015
Inactive	American Financial Security Life Insurance Co.	301635	Agent - Life	11/2/2012	5/14/2015
Denied	American General Life Insurance Company	301585	Agent - Health
Denied	American General Life Insurance Company	301585	Agent - Life
Active	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	2/17/2021
Active	Anthem Life Insurance Company	301209	Agent - Health	2/17/2021
Active	Anthem Life Insurance Company	301209	Agent - Life	2/17/2021
Inactive	CareSource Kentucky Co.	838179	Agent - Health	12/2/2021	2/3/2023
Inactive	Companion Life Insurance Company	300191	Agent - Health	2/16/2012	10/13/2014
Inactive	Family Life Insurance Company	300356	Agent - Health	6/18/2014	5/14/2015
Inactive	Family Life Insurance Company	300356	Agent - Life	6/18/2014	5/14/2015
Denied	Freedom Life Insurance Company of America	300074	Agent - Health
Denied	Freedom Life Insurance Company of America	300074	Agent - Life
Active	Golden Rule Insurance Company	301943	Agent - Health	2/8/2023
Active	Golden Rule Insurance Company	301943	Agent - Life	2/8/2023
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	10/23/2013	5/20/2014
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	10/23/2013	5/20/2014
Inactive	Humana Insurance Company	301104	Agent - Health	10/23/2013	5/20/2014
Inactive	Humana Insurance Company	301104	Agent - Life	10/23/2013	5/20/2014
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	10/23/2013	5/20/2014
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	10/23/2013	5/20/2014
Inactive	Independent Order of Foresters	300743	Agent - Life	4/20/2011	5/14/2015
Inactive	Madison National Life Insurance Company Inc.	301458	Agent - Life	2/22/2011	6/19/2012
Active	Molina Healthcare of Kentucky, Inc.	1035856	Agent - Health	11/8/2021
Inactive	Pioneer American Insurance Company	301268	Agent - Life	12/9/2010	9/28/2011
Inactive	Time Insurance Company	300683	Agent - Health	3/1/2012	10/21/2014
Inactive	Time Insurance Company	300683	Agent - Life	3/1/2012	10/21/2014
Inactive	WellCare Health Plans of Kentucky, Inc.	838592	Agent - Health	1/11/2022	12/22/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Assurance IQ, LLC	919554	Agent - Life	3/28/2023	5/15/2024
Inactive	Assurance IQ, LLC	919554	Agent - Health	3/28/2023	5/15/2024