DEPARTMENT OF INSURANCE

Affiliations

Name	Burgess, Lonzie	DOIID	781197	NAIC NPN	9894165

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Life	5/7/2012	3/31/2016
Inactive	Non Resident	Agent	Health	5/7/2012	3/31/2016
* 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	10/8/2015	3/31/2016
Inactive	Aetna Life Insurance Company	301140	Agent - Health	10/8/2015	3/31/2016
Inactive	Aetna Life Insurance Company	301140	Agent - Life	10/8/2015	3/31/2016
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	10/1/2015	11/2/2015
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	10/1/2015	11/2/2015
Inactive	Americo Financial Life and Annuity Insurance Company	300869	Agent - Life	3/16/2016	3/31/2016
Inactive	Colorado Bankers Life Insurance Company	301845	Agent - Health	2/11/2016	3/31/2016
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	7/24/2012	3/31/2016
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	7/24/2012	3/31/2016
Inactive	First Health Life & Health Insurance Company	301735	Agent - Health	10/8/2015	3/31/2016
Inactive	HCC Life Insurance Company	301827	Agent - Health	10/22/2015	3/31/2016
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	10/13/2014	3/31/2016
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	10/10/2012	3/31/2016
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	7/24/2012	3/31/2016
Inactive	Humana Insurance Company	301104	Agent - Health	7/13/2012	3/31/2016
Inactive	Humana Insurance Company	301104	Agent - Life	7/13/2012	3/31/2016
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	7/24/2012	3/31/2016
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	7/24/2012	3/31/2016
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	10/13/2014	3/31/2016
Inactive	Kanawha Insurance Company	300127	Agent - Health	7/13/2012	10/22/2015
Inactive	Kanawha Insurance Company	300127	Agent - Life	7/13/2012	10/22/2015
Inactive	Time Insurance Company	300683	Agent - Health	6/4/2012	12/20/2014
Inactive	Time Insurance Company	300683	Agent - Life	6/4/2012	12/20/2014

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	4/6/2015	3/31/2016
Inactive	Humana MarketPOINT Inc.	398092	Agent - Health	4/6/2015	3/31/2016