DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Simyak, Thomas	DOIID	733131	NAIC NPN	13275609

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	7/26/2010	6/30/2015
Inactive	Non Resident	Agent	Health	7/26/2010	6/30/2015
* 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	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	8/15/2010	9/17/2013
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Health	8/15/2010	10/12/2012
Inactive	Anthem Life Insurance Company	301209	Agent - Health	11/8/2013	6/30/2015
Inactive	Anthem Life Insurance Company	301209	Agent - Life	11/8/2013	6/30/2015
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	9/23/2013	8/14/2015
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	9/23/2013	8/14/2015
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	9/23/2013	8/14/2015
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	9/23/2013	8/14/2015
Inactive	Humana Insurance Company	301104	Agent - Health	9/23/2013	8/14/2015
Inactive	Humana Insurance Company	301104	Agent - Life	9/23/2013	8/14/2015
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	9/23/2013	8/14/2015
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	9/23/2013	8/14/2015
Inactive	Kanawha Insurance Company	300127	Agent - Health	9/23/2013	8/14/2015
Inactive	Kanawha Insurance Company	300127	Agent - Life	9/23/2013	8/14/2015

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	CBISA Reaquisitian Corp	547026	Agent - Health	12/10/2013	6/30/2015
Inactive	CBISA Reaquisitian Corp	547026	Agent - Life	12/10/2013	6/30/2015
Inactive	Designated Agent Company Inc.	681257	Agent - Health	11/8/2013	6/30/2015
Inactive	Designated Agent Company Inc.	681257	Agent - Life	11/8/2013	6/30/2015