DEPARTMENT OF INSURANCE

Affiliations

Name	Petri, Mark Vernon	DOIID	620765	NAIC NPN	1490783

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Life	11/8/2021	12/31/2026
Active	Non Resident	Agent	Health	11/8/2021	12/31/2026
* 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	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	7/1/2009	3/31/2013
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	7/1/2009	3/31/2013
Active	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	4/16/2023
Inactive	Anthem Life Insurance Company	301209	Agent - Health	4/16/2023	4/15/2025
Inactive	Anthem Life Insurance Company	301209	Agent - Life	4/16/2023	4/15/2025
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Health	8/26/2011	3/28/2017
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Life	8/26/2011	3/28/2017
Inactive	CIGNA Dental Health of Kentucky, Inc.	300904	Agent - Health	8/26/2011	5/11/2018
Inactive	CIGNA Health & Life Insurance Company	301783	Agent - Health	8/26/2011	5/11/2018
Inactive	CIGNA Health & Life Insurance Company	301783	Agent - Life	8/26/2011	5/11/2018
Active	CareSource Kentucky Co.	838179	Agent - Health	11/29/2022
Inactive	Connecticut General Life Insurance Company	301333	Agent - Health	8/26/2011	6/11/2014
Inactive	Connecticut General Life Insurance Company	301333	Agent - Life	8/26/2011	6/11/2014
Active	Golden Rule Insurance Company	301943	Agent - Health	11/17/2021
Active	Golden Rule Insurance Company	301943	Agent - Life	11/17/2021
Inactive	Guardian Life Insurance Company of America	301316	Agent - Health	8/26/2011	3/28/2017
Inactive	Guardian Life Insurance Company of America	301316	Agent - Life	8/26/2011	3/28/2017
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Health	8/26/2011	11/23/2012
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Life	8/26/2011	11/23/2012
Inactive	Medical Savings Insurance Company	301211	Agent - Health	12/13/2005	6/15/2009
Inactive	Medical Savings Insurance Company	301211	Agent - Life	12/13/2005	6/15/2009
Inactive	Metropolitan Life Insurance Company	301948	Agent - Health	8/26/2011	12/16/2014
Inactive	Metropolitan Life Insurance Company	301948	Agent - Life	8/26/2011	12/16/2014
Active	Molina Healthcare of Kentucky, Inc.	1035856	Agent - Health	9/18/2024
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	4/24/2008	8/15/2011
Active	National Health Insurance Company	300554	Agent - Health	2/9/2024
Active	National Health Insurance Company	300554	Agent - Life	2/9/2024
Inactive	United World Life Insurance Company	300532	Agent - Health	4/24/2008	12/15/2010
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	12/16/2008	8/15/2011
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	12/16/2008	8/15/2011
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	8/26/2011	12/1/2016
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	8/26/2011	12/1/2016
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	8/26/2011	12/1/2016
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	8/26/2011	12/1/2016

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	HealthMarkets Insurance Agency Inc	709727	Agent - Health	12/29/2021
Active	HealthMarkets Insurance Agency Inc	709727	Agent - Life	12/29/2021
Inactive	Paychex Insurance Agency Inc	509469	Agent - Health	11/3/2011	3/29/2017
Inactive	Paychex Insurance Agency Inc	509469	Agent - Life	11/3/2011	3/29/2017