DEPARTMENT OF INSURANCE

Affiliations

Name	Burgess, Mo	DOIID	906087	NAIC NPN	17848015

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Resident	Agent	Life	10/27/2016	9/30/2026
Active	Resident	Agent	Health	2/23/2016	9/30/2026
* 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	07/15/2024	09/30/2024	09/25/2024	09/25/2024	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Aetna Health Inc. (PA)	660717	Agent - Health	10/10/2023
Active	Aetna Health of Ohio Inc.	1065035	Agent - Health	10/10/2023
Active	Aetna Life Insurance Company	301140	Agent - Health	10/10/2023
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	2/23/2016	7/25/2018
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	11/20/2016	7/25/2018
Active	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	8/28/2023
Active	Anthem Health Plans of New Hampshire, Inc.	944064	Agent - Health	8/28/2023
Active	Anthem Insurance Companies, Inc.	300941	Agent - Health	8/28/2023
Active	Arcadian Health Plan, Inc.	728196	Agent - Health	8/15/2023
Active	Care Improvement Plus South Central Insurance Company	799697	Agent - Health	8/24/2023
Inactive	CompBenefits Insurance Company	301864	Agent - Health	10/7/2020	7/14/2023
Active	Compcare Health Services Insurance Corporation	948751	Agent - Health	8/28/2023
Inactive	Continental American Insurance Company	301700	Agent - Health	10/19/2016	9/6/2018
Inactive	Continental American Insurance Company	301700	Agent - Life	10/27/2016	9/6/2018
Active	Dental Concern Inc. (The)	301641	Agent - Health	7/26/2023
Active	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	8/15/2023
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	8/13/2020	7/14/2023
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	7/16/2018	7/14/2023
Active	Humana Insurance Company	301104	Agent - Health	8/15/2023
Inactive	Humana Insurance Company	301104	Agent - Life	7/16/2018	7/14/2023
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	7/16/2018	8/6/2020
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	7/16/2018	8/6/2020
Active	Humana Medical Plan, Inc.	801568	Agent - Health	8/15/2023
Active	Humana Wisconsin Health Organization Insurance Corporation	830687	Agent - Health	8/15/2023
Inactive	Independent Order of Foresters	300743	Agent - Health	2/1/2022	12/23/2022
Inactive	Independent Order of Foresters	300743	Agent - Life	2/1/2022	12/23/2022
Active	SilverScript Insurance Company	663526	Agent - Health	10/10/2023
Inactive	United World Life Insurance Company	300532	Agent - Health	3/12/2021	5/22/2023
Active	UnitedHealthcare Insurance Company	300946	Agent - Health	8/24/2023
Active	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	8/24/2023
Active	WellCare Health Insurance Company of Kentucky, Inc.	301478	Agent - Health	12/3/2023

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 - Health	6/18/2019	7/14/2023