DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Fulcrum Risk Management , LLC	DOIID	983803	NAIC NPN	18693778

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Health	2/6/2018	3/31/2022
Inactive	Resident	Agent	Life	2/6/2018	3/31/2022
Denied	Resident	Life & Health Consultant	Not Applicable
* 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	Arcadian Health Plan, Inc.	728196	Agent - Health	3/7/2018	6/15/2018
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	3/7/2018	6/15/2018
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	3/7/2018	6/15/2018
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	3/7/2018	6/15/2018
Inactive	Humana Insurance Company	301104	Agent - Health	3/7/2018	4/7/2020
Inactive	Humana Insurance Company	301104	Agent - Life	3/7/2018	4/7/2020
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	3/7/2018	6/15/2018
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	3/7/2018	6/15/2018
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	3/7/2018	6/15/2018
Inactive	Humana Wisconsin Health Organization Insurance Corporation	830687	Agent - Health	3/7/2018	6/15/2018

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Williams, Brandon Neal	580223	Agent - Health	2/6/2018	3/31/2022
Inactive	Williams, Brandon Neal	580223	Agent - Life	2/6/2018	3/31/2022