DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Burns, Della Shamar	DOIID	763100	NAIC NPN	16354149

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	9/9/2011	6/30/2013
* 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	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	1/11/2012	6/30/2013
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	9/21/2011	11/17/2011
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	9/21/2011	11/17/2011
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	9/21/2011	11/17/2011
Inactive	Humana Insurance Company	301104	Agent - Health	9/21/2011	11/17/2011
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	9/21/2011	11/17/2011
Inactive	Kanawha Insurance Company	300127	Agent - Health	9/21/2011	11/17/2011
Inactive	Tier One Insurance Company	301056	Agent - Health	9/28/2012	12/10/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Corporate Call Center, Inc	695480	Agent - Health	10/5/2011	11/17/2011
Inactive	Designated Agent Company Inc.	681257	Agent - Health	1/11/2012	6/30/2013