DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Passley, Samuel V	DOIID	1088961	NAIC NPN	19506244

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	7/12/2020		9/30/2025
Active	Non Resident	Agent	Life	7/12/2020		9/30/2025
* 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
Active	Care Improvement Plus South Central Insurance Company	799697	Agent - Health	7/17/2022
Inactive	Freedom Life Insurance Company of America	300074	Agent - Health	7/14/2020	8/17/2022
Inactive	Freedom Life Insurance Company of America	300074	Agent - Life	7/14/2020	8/17/2022
Active	UnitedHealthcare Insurance Company	300946	Agent - Health	7/10/2022
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	7/10/2022	12/22/2022
Active	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	7/10/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Ushealth Advisors Llc	713288	Agent - Life	7/14/2020	8/17/2022
Inactive	Ushealth Advisors Llc	713288	Agent - Health	7/14/2020	8/17/2022