DEPARTMENT OF INSURANCE

Affiliations

Name	Chapman, Sandra M	DOIID	322840	NAIC NPN	829150

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Life	9/24/2013		2/28/2027
Active	Resident	Agent	Health	9/24/2013		2/28/2027
Active	Resident	Agent	Casualty	9/24/2013		2/28/2027
Active	Resident	Agent	Property	9/24/2013		2/28/2027
Inactive	Resident	Agent	General Lines	12/19/1997	8/15/2000
Inactive	Resident	Agent	Health Maintenance Organization	11/18/1996	3/1/2001
* 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
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Health	8/12/1997	5/16/2000
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	8/12/1997	5/16/2000
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	10/29/1993	9/16/1998
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	10/29/1993	9/16/1998
Inactive	American National Insurance Company	301861	Agent - Health	12/4/1996	7/18/2001
Inactive	American National Insurance Company	301861	Agent - Life	12/4/1996	7/18/2001
Inactive	Augustar Life Assurance Corporation	301113	Agent - Health	7/14/1992	10/17/1997
Inactive	Augustar Life Assurance Corporation	301113	Agent - Life	7/14/1992	10/17/1997
Inactive	Augustar Life Insurance Company	301816	Agent - Health	7/14/1992	10/17/1997
Inactive	Augustar Life Insurance Company	301816	Agent - Life	7/14/1992	10/17/1997
Inactive	CHA HMO, Inc.	300662	Agent - Health Maintenance Organization	11/18/1996	1/4/1999
Inactive	Canada Life Assurance Company	301192	Agent - Health	5/24/1996	12/28/1998
Inactive	Canada Life Assurance Company	301192	Agent - Life	5/24/1996	12/28/1998
Inactive	Companion Life Insurance Company	300191	Agent - Health	11/6/1997	10/18/1999
Inactive	Companion Life Insurance Company	300191	Agent - Life	11/6/1997	10/18/1999
Inactive	Conseco Medical Insurance Company	300719	Agent - Health	1/23/1997	12/15/1998
Inactive	Conseco Medical Insurance Company	300719	Agent - Life	1/23/1997	12/15/1998
Inactive	Direct General Life Insurance Company	301045	Agent - Health	5/31/1996	3/1/2001
Inactive	Direct General Life Insurance Company	301045	Agent - Life	5/31/1996	3/1/2001
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	3/1/2001	7/18/2001
Inactive	Humana Health Plan, Inc.	300142	Agent - Health Maintenance Organization	6/26/2000	3/1/2001
Inactive	Humana Insurance Company	301104	Agent - Health	6/26/2000	7/18/2001
Inactive	Humana Insurance Company	301104	Agent - Life	6/26/2000	7/18/2001
Inactive	Indianapolis Life Insurance Company	301381	Agent - Health	9/23/1997	2/8/1999
Inactive	Indianapolis Life Insurance Company	301381	Agent - Life	9/23/1997	2/8/1999
Inactive	Jackson National Life Insurance Company	300486	Agent - Life	2/8/1995	5/20/1999
Inactive	Kentucky Association of Counties - All Lines Fund	300006	Agent - Casualty	8/15/2000	7/18/2001
Inactive	Kentucky Association of Counties - All Lines Fund	300006	Agent - General Lines	9/3/1998	8/15/2000
Inactive	Kentucky Association of Counties - All Lines Fund	300006	Agent - Property	8/15/2000	7/18/2001
Inactive	LifeUSA Insurance Company	300386	Agent - Health	8/6/1997	5/16/2000
Inactive	LifeUSA Insurance Company	300386	Agent - Life	8/6/1997	5/16/2000
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	12/4/1996	7/14/1997
Inactive	National Guardian Life Insurance Company	300596	Agent - Health	7/2/1996	3/31/1999
Inactive	National Guardian Life Insurance Company	300596	Agent - Life	7/2/1996	3/31/1999
Inactive	New York Life Insurance Company	300431	Agent - Health	5/2/1996	4/24/2000
Inactive	New York Life Insurance Company	300431	Agent - Life	5/2/1996	4/24/2000
Inactive	Old Line Life Insurance Company of America (The)	301709	Agent - Life	4/17/1997	7/27/1998
Inactive	Protective Life Insurance Company	300638	Agent - Health	1/11/1996	7/18/2001
Inactive	Protective Life Insurance Company	300638	Agent - Life	1/11/1996	7/18/2001
Inactive	Reliance Insurance Company	300785	Agent - Casualty	8/15/2000	6/5/2001
Inactive	Reliance Insurance Company	300785	Agent - General Lines	12/19/1997	8/15/2000
Inactive	Reliance Insurance Company	300785	Agent - Property	8/15/2000	6/5/2001
Inactive	Reliance Surety Company	301224	Agent - General Lines	12/29/1998	8/15/2000
Inactive	Time Insurance Company	300683	Agent - Health	2/19/1997	2/9/2001
Inactive	Time Insurance Company	300683	Agent - Life	2/19/1997	2/9/2001
Inactive	Union Security Insurance Company	301844	Agent - Health	2/10/1997	7/17/1998
Inactive	Union Security Insurance Company	301844	Agent - Life	2/10/1997	7/17/1998
Inactive	United Pacific Insurance Company	300538	Agent - General Lines	12/29/1998	8/15/2000
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	11/17/1999	7/18/2001
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	11/17/1999	7/18/2001
Inactive	Washington National Insurance Company	300587	Agent - Health	4/20/1995	3/31/1997
Inactive	Washington National Insurance Company	300587	Agent - Life	4/20/1995	3/31/1997

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Arison Insurance Services, Inc.	401001	Agent - Life	8/31/1998	7/18/2001
Inactive	Arison Insurance Services, Inc.	401001	Agent - Health	8/31/1998	7/18/2001
Inactive	Kentucky Association of Counties Ins Agency Inc.	398642	Agent - Health Maintenance Organization	11/15/1999	3/1/2001
Inactive	Kentucky Association of Counties Ins Agency Inc.	398642	Agent - Life	7/6/1998	7/18/2001
Inactive	Kentucky Association of Counties Ins Agency Inc.	398642	Agent - Health	7/6/1998	7/18/2001
Inactive	West Kentucky Group Benefits	401049	Agent - Life	12/28/1998	7/18/2001
Inactive	West Kentucky Group Benefits	401049	Agent - Health	12/28/1998	7/18/2001