DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Dumoulin, Michael	DOIID	970947	NAIC NPN	17922626

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	10/5/2017		10/31/2025
Active	Non Resident	Agent	Life	10/5/2017		10/31/2025
* 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
Agent	08/15/2025	10/31/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	1/11/2018	1/3/2022
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	1/11/2018	1/3/2022
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	1/11/2018	1/3/2022
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	1/11/2018	4/30/2018

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	USI Insurance Services National, Inc	509421	Agent - Health	1/16/2018	10/9/2019
Inactive	USI Insurance Services National, Inc	509421	Agent - Life	1/16/2018	10/9/2019
Inactive	Usi Insurance Services LLC	669260	Agent - Health	12/27/2018	1/3/2022
Inactive	Usi Insurance Services LLC	669260	Agent - Life	12/27/2018	1/3/2022