DEPARTMENT OF INSURANCE

Affiliations

Name	United Capital Risk Management, LLC	DOIID	739083	NAIC NPN	15907756

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Life	9/3/2024	3/31/2026
Active	Non Resident	Agent	Health	9/3/2024	3/31/2026
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	01/15/2026	03/31/2026

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Aetna Health and Life Insurance Company	300523	Agent - Health	7/3/2018	1/3/2024
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	3/7/2019	1/3/2024
Inactive	American Continental Insurance Company	643130	Agent - Life	7/3/2018	8/11/2021
Inactive	Banner Life Insurance Company	301696	Agent - Life	5/12/2016	1/3/2024
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	7/3/2018	1/3/2024
Inactive	Midland National Life Insurance Company	300923	Agent - Life	12/7/2016	1/3/2024
Active	Pruco Life Insurance Company	300954	Agent - Life	11/14/2024

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Backora, Richard William	837912	Agent - Health	4/30/2016	2/13/2017
Inactive	Backora, Richard William	837912	Agent - Life	4/30/2016	2/13/2017
Inactive	Cass, David M	562627	Agent - Health	1/16/2020	4/27/2022
Inactive	Cass, David M	562627	Agent - Life	1/16/2020	4/27/2022
Inactive	Fritz, Robert F	1221260	Agent - Health	10/12/2022	1/3/2024
Inactive	Fritz, Robert F	1221260	Agent - Life	10/12/2022	1/3/2024
Inactive	Kelly, Heather Lynn	900397	Agent - Health	2/15/2017	1/16/2020
Inactive	Kelly, Heather Lynn	900397	Agent - Life	2/15/2017	1/16/2020
Denied	Latini, Gregory	905282	Agent - Health
Denied	Latini, Gregory	905282	Agent - Life
Denied	Mcdonald, Thomas K	960371	Agent - Health
Denied	Mcdonald, Thomas K	960371	Agent - Life
Active	Rivers, James Francis	1304398	Agent - Health	3/31/2024
Active	Rivers, James Francis	1304398	Agent - Life	9/3/2024
Denied	Roller, Ryan	1026327	Agent - Health
Inactive	Roller, Ryan	1026327	Agent - Life	2/12/2019	12/20/2023
Inactive	Slafsky, Neal Aaron	736924	Agent - Health	10/7/2010	4/21/2014
Inactive	Slafsky, Neal Aaron	736924	Agent - Life	10/7/2010	4/21/2014
Inactive	Snyder, Christian	1116326	Agent - Health	4/1/2022	1/11/2023
Inactive	Snyder, Christian	1116326	Agent - Life	4/1/2022	1/11/2023
Inactive	Surenkamp, Raymond M	565337	Agent - Life	5/2/2018	12/20/2021
Denied	Weatherly, Brian Robert	1028880	Agent - Health
Denied	Weatherly, Brian Robert	1028880	Agent - Life
Denied	Wolfe, Robert Brian	749436	Agent - Health
Denied	Wolfe, Robert Brian	749436	Agent - Life