DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Derrick, Lisa Yvette	DOIID	782743	NAIC NPN	16362672

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	5/25/2012	8/31/2014
Inactive	Non Resident	Agent	Health	5/25/2012	8/31/2014
* 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	7/5/2012	8/31/2014
Inactive	Aetna Life Insurance Company	301140	Agent - Health	7/5/2012	8/31/2014
Inactive	Aetna Life Insurance Company	301140	Agent - Life	7/5/2012	8/31/2014
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	11/20/2012	5/1/2014
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	11/20/2012	5/1/2014
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	11/13/2013	5/1/2014
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	11/20/2012	5/1/2014
Inactive	Humana Insurance Company	301104	Agent - Health	11/20/2012	5/1/2014
Inactive	Humana Insurance Company	301104	Agent - Life	11/20/2012	5/1/2014
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	11/13/2013	5/1/2014
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	1/23/2014	5/1/2014
Inactive	Kanawha Insurance Company	300127	Agent - Health	11/20/2012	5/1/2014
Inactive	Kanawha Insurance Company	300127	Agent - Life	11/20/2012	5/1/2014
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	6/15/2012	1/16/2014
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	6/15/2012	1/16/2014
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	6/15/2012	1/16/2014
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	6/15/2012	1/16/2014

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Designated Agent Company Inc.	681257	Agent - Life	12/2/2013	3/20/2014
Inactive	Designated Agent Company Inc.	681257	Agent - Health	12/2/2013	3/20/2014
Inactive	Paychex Insurance Agency Inc	509469	Agent - Life	6/21/2012	1/2/2014
Inactive	Paychex Insurance Agency Inc	509469	Agent - Health	6/21/2012	1/2/2014