DEPARTMENT OF INSURANCE

Affiliations

Name	Commission Fund 4 LLC	DOIID	897898	NAIC NPN	17620535

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Health	11/3/2015	3/31/2027
Active	Non Resident	Agent	Life	11/3/2015	3/31/2027
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	01/15/2027	03/31/2027

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	American Retirement Life Insurance Company	706303	Agent - Health	1/21/2020	12/22/2020
Inactive	Bankers Fidelity Assurance Company	554627	Agent - Health	9/23/2019	5/23/2023
Inactive	Bankers Fidelity Assurance Company	554627	Agent - Life	9/23/2019	5/23/2023
Inactive	Bankers Fidelity Life Insurance Company	300193	Agent - Health	9/23/2019	5/23/2023
Inactive	Bankers Fidelity Life Insurance Company	300193	Agent - Life	9/23/2019	5/23/2023
Inactive	Banner Life Insurance Company	301696	Agent - Life	10/17/2018	3/31/2025
Active	Care Improvement Plus South Central Insurance Company	799697	Agent - Health	7/20/2022
Inactive	Central States Indemnity Company of Omaha	300285	Agent - Health	11/24/2015	8/13/2018
Inactive	Columbian Life Insurance Company	300810	Agent - Life	7/6/2022	7/18/2024
Inactive	Elips Life Insurance Company	301087	Agent - Health	4/14/2022	1/23/2025
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	2/18/2017	2/23/2018
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	2/18/2017	4/20/2018
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	2/18/2017	4/20/2018
Inactive	Lumico Life Insurance Company	300354	Agent - Health	1/19/2020	2/17/2023
Inactive	Medico Corp Life Insurance Company	301777	Agent - Health	8/18/2017	3/14/2018
Inactive	Medico Corp Life Insurance Company	301777	Agent - Life	8/18/2017	3/14/2018
Inactive	Medico Insurance Company	301559	Agent - Health	8/18/2017	12/26/2018
Inactive	Medico Insurance Company	301559	Agent - Life	8/18/2017	12/26/2018
Inactive	Medico Life and Health Insurance Company	907406	Agent - Health	10/8/2018	12/28/2020
Inactive	Medico Life and Health Insurance Company	907406	Agent - Life	10/8/2018	12/28/2020
Active	UnitedHealthcare Insurance Company	300946	Agent - Health	5/21/2020
Inactive	UnitedHealthcare Insurance Company of America	301552	Agent - Health	11/14/2016	12/20/2018
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	5/21/2020	12/22/2022
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	5/21/2020	12/23/2021
Active	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	5/21/2020

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Emerton, David L	319947	Agent - Health	11/3/2015
Active	Emerton, David L	319947	Agent - Life	11/3/2015