DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Actuarial Development Services Corporation LLC	DOIID	712572	NAIC NPN	14757079

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	9/1/2009		3/31/2027
Active	Non Resident	Agent	Life	9/1/2009		3/31/2027
* 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 Equity Investment Life Insurance Company	300389	Agent - Life	6/8/2010	12/19/2022
Active	Baltimore Life Insurance Company	300286	Agent - Life	10/28/2015
Active	Forethought Life Insurance Company	301407	Agent - Health	11/23/2010
Active	Forethought Life Insurance Company	301407	Agent - Life	11/11/2009
Inactive	Metropolitan Life Insurance Company	301948	Agent - Health	11/21/2009	5/26/2011
Inactive	Metropolitan Life Insurance Company	301948	Agent - Life	11/21/2009	5/26/2011
Active	Nassau Life Insurance Company of Kansas	300667	Agent - Health	10/15/2020
Inactive	Nassau Life and Annuity Company	513671	Agent - Life	4/15/2019	12/28/2022
Inactive	PHL Variable Insurance Company	300525	Agent - Life	11/15/2013	12/2/2020
Active	Sentinel Security Life Insurance Company	935789	Agent - Health	8/11/2022
Active	Sentinel Security Life Insurance Company	935789	Agent - Life	8/11/2022
Active	United American Insurance Company	300910	Agent - Health	11/5/2024
Active	United American Insurance Company	300910	Agent - Life	11/5/2024

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Graham, Mark Burnside	638756	Agent - Health	4/12/2018	5/26/2022
Inactive	Graham, Mark Burnside	638756	Agent - Life	4/12/2018	5/26/2022
Active	Graham, Matthew B	640480	Agent - Health	5/26/2022
Active	Graham, Matthew B	640480	Agent - Life	5/26/2022
Inactive	North, Timothy Owen	514133	Agent - Health	9/1/2009	4/13/2018
Inactive	North, Timothy Owen	514133	Agent - Life	9/1/2009	4/13/2018