DEPARTMENT OF INSURANCE

Affiliations

Name	Peterson, Thomas D	DOIID	772945	NAIC NPN	6927716

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Health	1/19/2012	4/30/2019
Inactive	Non Resident	Agent	Life	1/19/2012	4/30/2019
* 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	Aetna Health Inc. (PA)	660717	Agent - Health	9/22/2015	4/30/2019
Inactive	Aetna Life Insurance Company	301140	Agent - Health	9/22/2015	4/30/2019
Inactive	Aetna Life Insurance Company	301140	Agent - Life	9/22/2015	4/30/2019
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	7/13/2015	12/8/2015
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	7/13/2015	12/8/2015
Inactive	First Health Life & Health Insurance Company	301735	Agent - Health	9/22/2015	4/30/2019
Inactive	Guarantee Trust Life Insurance Company	301043	Agent - Health	2/21/2014	12/28/2018
Inactive	Guarantee Trust Life Insurance Company	301043	Agent - Life	2/21/2014	12/28/2018
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	7/13/2015	5/2/2016
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	7/13/2015	5/2/2016
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	7/13/2015	5/2/2016
Inactive	Humana Insurance Company	301104	Agent - Health	7/13/2015	6/14/2016
Inactive	Humana Insurance Company	301104	Agent - Life	7/13/2015	6/14/2016
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	7/13/2015	6/14/2016
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	7/13/2015	6/14/2016
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	7/13/2015	5/2/2016
Inactive	Humana Wisconsin Health Organization Insurance Corporation	830687	Agent - Health	10/12/2016	4/20/2018
Inactive	Kanawha Insurance Company	300127	Agent - Health	7/13/2015	10/22/2015
Inactive	Kanawha Insurance Company	300127	Agent - Life	7/13/2015	10/22/2015
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	4/30/2014	6/22/2015
Inactive	Omaha Insurance Company	751908	Agent - Health	3/30/2012	6/24/2013
Inactive	Reserve National Insurance Company	301073	Agent - Health	1/28/2015	2/10/2016
Inactive	Reserve National Insurance Company	301073	Agent - Life	1/28/2015	2/10/2016
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	10/14/2015	8/22/2016
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	10/14/2015	8/22/2016

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	GoldenCare USA, LLC	398142	Agent - Life	11/3/2016	4/30/2019
Inactive	GoldenCare USA, LLC	398142	Agent - Health	11/3/2016	4/30/2019
Inactive	National Independent Brokers, LLC	502029	Agent - Life	11/3/2016	4/30/2019
Inactive	National Independent Brokers, LLC	502029	Agent - Health	11/3/2016	4/30/2019