DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Fortune Ins Solutions LLC	DOIID	955554	NAIC NPN	9137209

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	5/26/2017	1/23/2020
Inactive	Non Resident	Agent	Health	5/26/2017	1/23/2020
* 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	Dental Concern Inc. (The)	301641	Agent - Health	6/12/2019	12/19/2019
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	6/10/2019	12/19/2019
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	6/10/2019	12/19/2019
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	6/10/2019	12/19/2019
Inactive	Humana Insurance Company	301104	Agent - Health	6/10/2019	12/19/2019
Inactive	Humana Insurance Company	301104	Agent - Life	6/10/2019	12/19/2019
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	6/10/2019	12/19/2019
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	6/10/2019	12/19/2019
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	6/10/2019	12/19/2019
Inactive	Humana Wisconsin Health Organization Insurance Corporation	830687	Agent - Health	6/10/2019	12/19/2019
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	6/12/2017	1/23/2020
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	6/12/2017	1/23/2020
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	6/12/2017	1/23/2020
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	6/12/2017	4/30/2018

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Ptolomey, Mark Ian	955273	Agent - Health	5/26/2017	1/23/2020
Inactive	Ptolomey, Mark Ian	955273	Agent - Life	5/26/2017	1/23/2020