DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Burlsworth, Grady A	DOIID	749214	NAIC NPN	2261248

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	9/11/2023		11/30/2025
Active	Non Resident	Agent	Life	9/11/2023		11/30/2025
* 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	09/15/2025	11/30/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Aetna Health Inc. (PA)	660717	Agent - Health	9/16/2023
Active	Aetna Health of Ohio Inc.	1065035	Agent - Health	9/16/2023
Active	Aetna Life Insurance Company	301140	Agent - Health	9/16/2023
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	8/31/2013	11/30/2013
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	8/31/2013	11/30/2013
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	8/31/2013	11/30/2013
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	8/31/2013	11/30/2013
Inactive	Humana Insurance Company	301104	Agent - Health	8/31/2013	11/30/2013
Inactive	Humana Insurance Company	301104	Agent - Life	8/31/2013	11/30/2013
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	8/31/2013	11/30/2013
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	8/31/2013	11/30/2013
Inactive	HumanaDental Insurance Company	301457	Agent - Health	3/16/2011	2/24/2012
Inactive	HumanaDental Insurance Company	301457	Agent - Life	3/16/2011	2/24/2012
Inactive	Kanawha Insurance Company	300127	Agent - Health	8/31/2013	11/30/2013
Inactive	Kanawha Insurance Company	300127	Agent - Life	8/31/2013	11/30/2013
Active	SilverScript Insurance Company	663526	Agent - Health	9/16/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Humana MarketPOINT Inc.	398092	Agent - Life	4/6/2011	8/2/2013
Inactive	Humana MarketPOINT Inc.	398092	Agent - Health	4/6/2011	8/2/2013