DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Czonstka, Kirk	DOIID	799621	NAIC NPN	9595820

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	12/14/2012	10/25/2018
Inactive	Non Resident	Agent	Life	12/14/2012	10/25/2018
* 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	Baptist Health Plan, Inc.	300157	Agent - Health	3/29/2013	10/25/2018

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Mercer Health & Benefits LLC	607080	Agent - Life
Inactive	Mercer Health & Benefits LLC	607080	Agent - Health	3/29/2013	10/25/2018