DEPARTMENT OF INSURANCE

Affiliations

Name	Fortner, Terry Gene	DOIID	587713	NAIC NPN	8043019

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Resident	Agent	Health	4/21/2004	7/31/2026
Active	Resident	Agent	Life	4/22/2004	7/31/2026
Denied	Resident	Agent	Casualty
Denied	Resident	Agent	Property
* 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	Acacia Life Insurance Company	300375	Agent - Health	12/8/2008	4/1/2011
Inactive	Acacia Life Insurance Company	300375	Agent - Life	12/8/2008	4/1/2011
Inactive	American Continental Insurance Company	643130	Agent - Health	11/8/2012	6/6/2016
Inactive	American Continental Insurance Company	643130	Agent - Life	11/8/2012	12/15/2020
Active	American General Life Insurance Company	301585	Agent - Health	6/12/2017
Active	American General Life Insurance Company	301585	Agent - Life	6/12/2017
Inactive	American General Life and Accident Insurance Company	301362	Agent - Health	4/21/2004	1/21/2005
Inactive	American General Life and Accident Insurance Company	301362	Agent - Life	4/22/2004	1/21/2005
Inactive	American Memorial Life Insurance Company	301445	Agent - Life	4/7/2018	5/21/2019
Inactive	American Retirement Life Insurance Company	706303	Agent - Health	1/2/2014	12/28/2015
Inactive	American Retirement Life Insurance Company	706303	Agent - Life	1/2/2014	12/28/2015
Inactive	Americo Financial Life and Annuity Insurance Company	300869	Agent - Life	8/8/2018	6/7/2022
Inactive	Ameritas Life Insurance Corporation	300126	Agent - Health	12/31/2016	10/26/2021
Inactive	Ameritas Life Insurance Corporation	300126	Agent - Life	12/31/2016	10/26/2021
Inactive	Athene Annuity & Life Assurance Company of New York	300724	Agent - Life	11/19/2007	5/8/2013
Inactive	Athene Annuity and Life Company	301893	Agent - Life	3/11/2011	11/29/2021
Inactive	Baltimore Life Insurance Company	300286	Agent - Life	5/7/2013	10/17/2015
Active	CIGNA Health & Life Insurance Company	301783	Agent - Health	1/9/2014
Active	CIGNA Health & Life Insurance Company	301783	Agent - Life	1/9/2014
Active	Colonial Life and Accident Insurance Company	300846	Agent - Health	1/6/2009
Active	Colonial Life and Accident Insurance Company	300846	Agent - Life	1/6/2009
Inactive	Columbian Life Insurance Company	300810	Agent - Life	3/24/2009	6/18/2019
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	2/28/2014	8/14/2015
Inactive	Connecticut General Life Insurance Company	301333	Agent - Health	2/17/2011	6/11/2014
Inactive	Connecticut General Life Insurance Company	301333	Agent - Life	2/17/2011	6/11/2014
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	2/28/2014	8/14/2015
Inactive	EquiTrust Life Insurance Company	502870	Agent - Life	5/24/2013	7/16/2015
Inactive	Everly Life Insurance Company	561641	Agent - Life	1/2/2014	3/7/2017
Inactive	Fidelity & Guaranty Life Insurance Company	301359	Agent - Life	2/28/2012	11/13/2015
Inactive	Fidelity Life Association, A Legal Reserve Life Insurance Company	300774	Agent - Life	3/5/2009	7/26/2016
Inactive	Forethought Life Insurance Company	301407	Agent - Health	8/9/2011	10/30/2014
Active	Forethought Life Insurance Company	301407	Agent - Life	3/10/2021
Inactive	Genworth Life and Annuity Insurance Company	301276	Agent - Health	12/20/2008	12/7/2012
Inactive	Genworth Life and Annuity Insurance Company	301276	Agent - Life	12/20/2008	12/7/2012
Inactive	Gerber Life Insurance Company	300529	Agent - Health	4/25/2016	2/7/2019
Inactive	Gerber Life Insurance Company	300529	Agent - Life	4/25/2016	2/7/2019
Inactive	Golden Rule Insurance Company	301943	Agent - Health	11/10/2005	6/9/2008
Inactive	Golden Rule Insurance Company	301943	Agent - Life	11/10/2005	6/9/2008
Inactive	Guarantee Trust Life Insurance Company	301043	Agent - Health	7/26/2011	3/23/2016
Inactive	Guarantee Trust Life Insurance Company	301043	Agent - Life	7/26/2011	3/23/2016
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	2/28/2014	8/14/2015
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	2/28/2014	8/14/2015
Inactive	Humana Insurance Company	301104	Agent - Health	2/28/2014	8/14/2015
Inactive	Humana Insurance Company	301104	Agent - Life	2/28/2014	8/14/2015
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	2/28/2014	8/14/2015
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	2/28/2014	8/14/2015
Inactive	Illinois Mutual Life Insurance Company	301479	Agent - Health	5/12/2010	11/12/2012
Inactive	Illinois Mutual Life Insurance Company	301479	Agent - Life	5/12/2010	11/12/2012
Denied	Independent Mutual Fire Insurance Company	300851	Agent - Casualty
Denied	Independent Mutual Fire Insurance Company	300851	Agent - Property
Inactive	Independent Order of Foresters	300743	Agent - Life	3/25/2010	12/19/2014
Inactive	John Alden Life Insurance Company	300573	Agent - Health	1/7/2009	12/29/2010
Inactive	John Alden Life Insurance Company	300573	Agent - Life	1/7/2009	12/29/2010
Inactive	Kanawha Insurance Company	300127	Agent - Health	2/28/2014	8/14/2015
Inactive	Kanawha Insurance Company	300127	Agent - Life	2/28/2014	8/14/2015
Active	Liberty Bankers Life Insurance Company	542461	Agent - Life	12/16/2015
Inactive	Medico Corp Life Insurance Company	301777	Agent - Health	5/19/2016	12/21/2016
Inactive	Medico Corp Life Insurance Company	301777	Agent - Life	5/19/2016	12/21/2016
Inactive	Medico Insurance Company	301559	Agent - Health	11/11/2016	12/26/2018
Inactive	Medico Insurance Company	301559	Agent - Life	11/11/2016	12/26/2018
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	6/16/2012	6/24/2013
Inactive	Nassau Life Insurance Company of Texas	300872	Agent - Health	10/28/2009	9/13/2012
Inactive	Nassau Life Insurance Company of Texas	300872	Agent - Life	10/28/2009	9/13/2012
Inactive	North American Company for Life and Health Insurance	300291	Agent - Health	4/30/2013	9/29/2015
Inactive	North American Company for Life and Health Insurance	300291	Agent - Life	4/30/2013	9/29/2015
Inactive	Occidental Life Insurance Company of North Carolina	301185	Agent - Life	3/27/2017	8/7/2018
Inactive	Omaha Insurance Company	751908	Agent - Health	4/11/2017	2/22/2018
Active	Physicians Life Insurance Company	300924	Agent - Life	12/27/2023
Active	Renaissance Life & Health Insurance Company of America	301447	Agent - Health	6/24/2015
Inactive	Royal Neighbors of America	301646	Agent - Life	3/27/2013	10/21/2015
Inactive	S.USA Life Insurance Company, Inc.	301774	Agent - Life	1/22/2018	6/24/2019
Inactive	SILAC Insurance Company	300535	Agent - Health	3/22/2011	11/10/2020
Inactive	SILAC Insurance Company	300535	Agent - Life	3/22/2011	11/10/2020
Inactive	Security Life Insurance Company of America	300936	Agent - Health	7/16/2015	12/31/2016
Inactive	Security Life Insurance Company of America	300936	Agent - Life	7/16/2015	12/31/2016
Inactive	Security National Life Insurance Company	569786	Agent - Life	5/22/2014	8/1/2018
Inactive	Sterling Life Insurance Company	301947	Agent - Health	10/5/2011	11/30/2012
Inactive	Stonebridge Life Insurance Company	301614	Agent - Health	1/16/2015	10/1/2015
Inactive	Stonebridge Life Insurance Company	301614	Agent - Life	1/16/2015	10/1/2015
Inactive	Time Insurance Company	300683	Agent - Health	3/10/2015	11/25/2019
Inactive	Time Insurance Company	300683	Agent - Life	3/10/2015	11/25/2019
Inactive	Transamerica Life Insurance Company	300571	Agent - Health	10/1/2015	6/26/2017
Inactive	Transamerica Life Insurance Company	300571	Agent - Life	10/1/2015	6/26/2017
Inactive	Transamerica Premier Life Insurance Company	300558	Agent - Health	6/23/2017	11/12/2018
Inactive	Transamerica Premier Life Insurance Company	300558	Agent - Life	6/23/2017	11/12/2018
Inactive	Trinity Life Insurance Company	552459	Agent - Life	4/11/2016	5/4/2017
Inactive	Union Central Life Insurance Company	300307	Agent - Health	12/8/2008	12/31/2012
Inactive	Union Central Life Insurance Company	300307	Agent - Life	12/8/2008	12/31/2012
Inactive	United American Insurance Company	300910	Agent - Life	5/13/2016	2/25/2019
Inactive	United World Life Insurance Company	300532	Agent - Health	7/12/2005	11/9/2010
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	3/17/2011	12/26/2012
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	3/17/2011	12/26/2012
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	9/27/2011	3/9/2016
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	9/27/2011	3/9/2016
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	9/12/2015	3/9/2016
Inactive	Wysh Life and Health Insurance Company	779030	Agent - Health	10/26/2012	3/31/2015

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Barnett-Strother Funeral Home LLC	748555	Agent - Life	11/8/2022	3/31/2023
Active	Cornerstone Senior Services LLC	399590	Agent - Health	3/15/2011
Active	Cornerstone Senior Services LLC	399590	Agent - Life	3/15/2011
Inactive	Designated Agent Company Inc.	681257	Agent - Health	12/11/2013	4/20/2016
Inactive	Designated Agent Company Inc.	681257	Agent - Life	12/11/2013	4/20/2016
Inactive	Medlink Inc	400721	Agent - Health	1/6/2009	3/31/2024
Inactive	Medlink Inc	400721	Agent - Life	1/6/2009	3/31/2024