DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Burgess, Jamie	DOIID	764996	NAIC NPN	8958190

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	9/28/2011	9/30/2013
Inactive	Non Resident	Agent	Life	9/28/2011	9/30/2013
Active	Non Resident	Staff Adjuster	Property & Casualty	5/11/2018		9/30/2025
* 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
Staff Adjuster	07/15/2025	09/30/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	10/31/2011	11/15/2011
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	10/31/2011	11/15/2011
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	10/31/2011	11/15/2011
Inactive	Humana Insurance Company	301104	Agent - Health	10/31/2011	11/15/2011
Inactive	Humana Insurance Company	301104	Agent - Life	10/31/2011	11/15/2011
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	10/31/2011	11/15/2011
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	10/31/2011	11/15/2011
Inactive	Kanawha Insurance Company	300127	Agent - Health	10/31/2011	11/15/2011
Inactive	Kanawha Insurance Company	300127	Agent - Life	10/31/2011	11/15/2011

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Humana MarketPOINT Inc.	398092	Agent - Health
Denied	Humana MarketPOINT Inc.	398092	Agent - Life