DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Concourse Distributors, Inc.	DOIID	1371564	NAIC NPN	21372834

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	11/11/2024		3/31/2028
Active	Non Resident	Agent	Life	11/11/2024		3/31/2028
* 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	01/07/2026	01/07/2026	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Banner Life Insurance Company	301696	Agent - Life	7/31/2025
Active	Nationwide Life and Annuity Insurance Company	300714	Agent - Health	12/11/2025
Active	Nationwide Life and Annuity Insurance Company	300714	Agent - Life	12/11/2025
Active	Pruco Life Insurance Company	300954	Agent - Life	7/29/2025

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Carlson, Martha Louisa Hart	1069618	Agent - Health	11/11/2024
Active	Carlson, Martha Louisa Hart	1069618	Agent - Life	11/11/2024