DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Burm, Timothy Jon	DOIID	763107	NAIC NPN	15728470

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	9/6/2013
Inactive	Non Resident	Agent	Life	9/9/2011	9/6/2013
* 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	CompBenefits Dental, Inc.	591692	Agent - Health	9/20/2011	9/14/2012
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	9/20/2011	9/14/2012
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	9/20/2011	9/14/2012
Inactive	Humana Insurance Company	301104	Agent - Health	9/20/2011	9/14/2012
Inactive	Humana Insurance Company	301104	Agent - Life	9/20/2011	9/14/2012
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	9/20/2011	9/14/2012
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	9/20/2011	9/14/2012
Inactive	HumanaDental Insurance Company	301457	Agent - Health	11/16/2011	2/24/2012
Inactive	HumanaDental Insurance Company	301457	Agent - Life	11/16/2011	2/24/2012
Inactive	Kanawha Insurance Company	300127	Agent - Health	9/20/2011	9/14/2012
Inactive	Kanawha Insurance Company	300127	Agent - Life	9/20/2011	9/14/2012

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	10/19/2011	9/14/2012
Inactive	Humana MarketPOINT Inc.	398092	Agent - Health	10/19/2011	9/14/2012