DEPARTMENT OF INSURANCE

Affiliations

Name	Southworth, Shirley William	DOIID	338829	NAIC NPN	138785

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Health	6/26/1988		8/31/2024
Active	Resident	Agent	Property	8/15/2000		8/31/2024
Active	Resident	Agent	Casualty	8/4/2000		8/31/2024
Active	Resident	Agent	Life	6/26/1988		8/31/2024
Inactive	Resident	Agent	General Lines	6/5/1975	8/15/2000
* 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	06/15/2024	08/31/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	AIG Assurance Company	300897	Agent - Casualty	8/15/2000	9/24/2010
Inactive	AIG Assurance Company	300897	Agent - General Lines	5/5/1994	8/15/2000
Inactive	AIG Assurance Company	300897	Agent - Property	8/15/2000	9/24/2010
Inactive	American Equity Investment Life Insurance Company	300389	Agent - Life	6/12/2009	11/11/2011
Active	American Family Home Insurance Company	301817	Agent - Casualty	12/6/2021
Active	American Family Home Insurance Company	301817	Agent - Property	12/6/2021
Inactive	American Modern Home Insurance Company	300791	Agent - Casualty	8/15/2000	11/29/2021
Inactive	American Modern Home Insurance Company	300791	Agent - General Lines	5/23/1998	8/15/2000
Inactive	American Modern Home Insurance Company	300791	Agent - Property	8/15/2000	11/29/2021
Inactive	American National Life Insurance Company of Texas	300912	Agent - Health	3/28/2007	11/23/2010
Inactive	American National Life Insurance Company of Texas	300912	Agent - Life	3/28/2007	11/23/2010
Inactive	American Republic Insurance Company	300861	Agent - Health	10/9/1990	12/14/2000
Inactive	American Republic Insurance Company	300861	Agent - Life	10/9/1990	12/14/2000
Inactive	Americo Financial Life and Annuity Insurance Company	300869	Agent - Health	9/26/2006	11/15/2008
Inactive	Americo Financial Life and Annuity Insurance Company	300869	Agent - Life	9/26/2006	11/15/2008
Inactive	Assurance Company of America	300432	Agent - General Lines	9/13/1994	3/31/1996
Inactive	Automobile Insurance Company of Hartford, Connecticut	300630	Agent - General Lines	4/29/1997	10/18/1999
Active	Bristol West Insurance Company	301655	Agent - Casualty	11/6/2008
Active	Bristol West Insurance Company	301655	Agent - Property	11/6/2008
Inactive	Central States Indemnity Company of Omaha	300285	Agent - Health	11/11/2011	8/13/2018
Inactive	Charter Oak Fire Insurance Company (The)	301501	Agent - General Lines	4/29/1997	10/18/1999
Active	Citizens Security Life Insurance Company	301257	Agent - Life	11/17/2009
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	8/28/2008	9/8/2010
Inactive	CompBenefits Insurance Company	301864	Agent - Health	8/28/2008	9/8/2010
Inactive	CompBenefits Insurance Company	301864	Agent - Life	8/28/2008	9/8/2010
Inactive	Continental General Insurance Company	300691	Agent - Health	12/5/1990	12/28/1998
Inactive	Continental General Insurance Company	300691	Agent - Life	12/5/1990	12/28/1998
Active	Dairyland Insurance Company	301370	Agent - Casualty	11/26/2001
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	6/21/2010	9/8/2010
Inactive	Encova Life Insurance Company	301818	Agent - Life	3/20/2009	11/30/2017
Inactive	Falls Lake National Insurance Company	301796	Agent - Casualty	8/4/2000	12/15/2003
Inactive	Farmers Insurance Exchange	300336	Agent - Casualty	2/4/2008	8/22/2012
Inactive	Farmers Insurance Exchange	300336	Agent - Property	2/4/2008	8/22/2012
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	3/5/2003
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	3/5/2003
Inactive	Foremost Signature Insurance Company	300140	Agent - Casualty	3/5/2003	12/1/2003
Inactive	Foremost Signature Insurance Company	300140	Agent - Property	3/5/2003	12/1/2003
Inactive	Forethought Life Insurance Company	301407	Agent - Life	2/22/2007	3/9/2010
Inactive	Generali - U.S. Branch	301128	Agent - Casualty	8/15/2000	3/31/2002
Inactive	Generali - U.S. Branch	301128	Agent - General Lines	7/8/1991	8/15/2000
Inactive	Generali - U.S. Branch	301128	Agent - Property	8/15/2000	3/31/2002
Inactive	Gerber Life Insurance Company	300529	Agent - Health	10/28/2009	12/15/2011
Inactive	Gerber Life Insurance Company	300529	Agent - Life	10/28/2009	12/15/2011
Inactive	Glatfelter Insurance Company	301640	Agent - General Lines	9/13/1994	3/31/1996
Inactive	Globe American Casualty Company	301033	Agent - Casualty	8/15/2000	3/6/2003
Inactive	Globe American Casualty Company	301033	Agent - General Lines	2/23/1998	8/15/2000
Inactive	Globe American Casualty Company	301033	Agent - Property	8/15/2000	3/6/2003
Inactive	Golden Rule Insurance Company	301943	Agent - Health	6/26/1988	11/12/1998
Inactive	Golden Rule Insurance Company	301943	Agent - Life	6/26/1988	11/12/1998
Inactive	Grange Life Insurance Company	300128	Agent - Health	10/15/2015	12/22/2016
Inactive	Grange Life Insurance Company	300128	Agent - Life	10/15/2015	12/22/2016
Inactive	Granite State Insurance Company	300818	Agent - Casualty	8/15/2000	9/24/2010
Inactive	Granite State Insurance Company	300818	Agent - General Lines	6/23/2000	8/15/2000
Inactive	Granite State Insurance Company	300818	Agent - Property	8/15/2000	9/24/2010
Inactive	Hallmark National Insurance Company	300494	Agent - Casualty	7/24/2009	1/22/2018
Inactive	Hallmark National Insurance Company	300494	Agent - Property	7/24/2009	1/22/2018
Inactive	Hartford Accident and Indemnity Company	301917	Agent - Casualty	9/15/2003	12/2/2005
Inactive	Hartford Accident and Indemnity Company	301917	Agent - Property	9/15/2003	12/2/2005
Inactive	Hartford Casualty Insurance Company	301332	Agent - Casualty	8/15/2000	12/2/2005
Inactive	Hartford Casualty Insurance Company	301332	Agent - General Lines	6/23/1998	8/15/2000
Inactive	Hartford Casualty Insurance Company	301332	Agent - Property	8/15/2000	12/2/2005
Inactive	Hartford Fire Insurance Company	300628	Agent - Casualty	9/15/2003	12/2/2005
Inactive	Hartford Fire Insurance Company	300628	Agent - Property	9/15/2003	12/2/2005
Inactive	Hartford Insurance Company of the Midwest	301918	Agent - Casualty	9/15/2003	12/2/2005
Inactive	Hartford Insurance Company of the Midwest	301918	Agent - Property	9/15/2003	12/2/2005
Inactive	Hartford Underwriters Insurance Company	301064	Agent - Casualty	9/15/2003	12/2/2005
Inactive	Hartford Underwriters Insurance Company	301064	Agent - Property	9/15/2003	12/2/2005
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	9/28/2006	9/8/2010
Inactive	Humana Insurance Company	301104	Agent - Health	9/28/2006	9/8/2010
Inactive	Humana Insurance Company	301104	Agent - Life	9/28/2006	9/8/2010
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	9/28/2006	9/8/2010
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	9/28/2006	9/8/2010
Inactive	Illinois National Insurance Company	301367	Agent - Casualty	7/30/2003	9/24/2010
Inactive	Illinois National Insurance Company	301367	Agent - General Lines	10/24/1989	8/15/2000
Inactive	Illinois National Insurance Company	301367	Agent - Property	7/30/2003	9/24/2010
Inactive	Infinity Casualty Insurance Company	301280	Agent - Casualty	8/15/2000	12/15/2003
Inactive	Infinity Casualty Insurance Company	301280	Agent - General Lines	6/30/1980	8/15/2000
Inactive	Infinity Insurance Company	300416	Agent - General Lines	8/31/1994	3/31/1996
Inactive	Infinity Standard Insurance Company	301643	Agent - Casualty	8/15/2000	10/15/2004
Inactive	Infinity Standard Insurance Company	301643	Agent - General Lines	7/16/1992	8/15/2000
Inactive	Infinity Standard Insurance Company	301643	Agent - Property	8/15/2000	10/15/2004
Inactive	Integon National Insurance Company	301600	Agent - General Lines	10/18/1993	3/31/1998
Inactive	Inter-State Assurance Company	301556	Agent - Life	8/1/1997	5/10/2002
Inactive	Investors Heritage Life Insurance Company	300363	Agent - Health	2/17/1993	12/17/1998
Inactive	Investors Heritage Life Insurance Company	300363	Agent - Life	2/17/1993	12/17/1998
Inactive	Jackson National Life Insurance Company	300486	Agent - Life	8/13/1990	4/26/2001
Inactive	John Alden Life Insurance Company	300573	Agent - Health	1/26/2011	1/24/2013
Inactive	John Alden Life Insurance Company	300573	Agent - Life	1/26/2011	1/24/2013
Active	Kentucky Home Life Insurance Company	300477	Agent - Health	11/18/2020
Active	Kentucky Home Life Insurance Company	300477	Agent - Life	11/18/2020
Inactive	Kentucky National Insurance Company	301625	Agent - Casualty	8/15/2000	10/15/2003
Inactive	Kentucky National Insurance Company	301625	Agent - General Lines	5/8/1978	8/15/2000
Inactive	Kentucky National Insurance Company	301625	Agent - Property	8/15/2000	10/15/2003
Inactive	LifeUSA Insurance Company	300386	Agent - Health	2/16/1994	4/22/1996
Inactive	LifeUSA Insurance Company	300386	Agent - Life	2/16/1994	4/22/1996
Inactive	Lincoln General Insurance Company	301580	Agent - Casualty	1/19/2004	4/17/2006
Inactive	Lincoln General Insurance Company	301580	Agent - Property	1/19/2004	4/17/2006
Inactive	Lincoln Heritage Life Insurance Company	500016	Agent - Health	5/10/2013	1/11/2015
Inactive	Lincoln Heritage Life Insurance Company	500016	Agent - Life	5/10/2013	1/11/2015
Inactive	Maryland Casualty Company	301719	Agent - General Lines	9/13/1994	3/31/1996
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	5/9/2012	6/24/2013
Inactive	National Insurance Association	301386	Agent - Casualty	8/15/2000	3/6/2003
Inactive	National Insurance Association	301386	Agent - General Lines	7/27/1993	8/15/2000
Inactive	National Insurance Association	301386	Agent - Property	8/15/2000	3/6/2003
Inactive	National Summit Insurance Company	300348	Agent - Casualty	8/15/2000	7/23/2003
Inactive	National Summit Insurance Company	300348	Agent - General Lines	8/26/1996	8/15/2000
Inactive	National Summit Insurance Company	300348	Agent - Property	8/15/2000	7/23/2003
Inactive	North American Company for Life and Health Insurance	300291	Agent - Health	1/25/1994	10/28/1996
Inactive	North American Company for Life and Health Insurance	300291	Agent - Life	1/25/1994	10/28/1996
Inactive	Northern Insurance Company of New York	301317	Agent - General Lines	9/13/1994	3/31/1996
Inactive	Omaha Insurance Company	751908	Agent - Health	5/9/2012	6/24/2013
Inactive	Omni Indemnity Company	301456	Agent - Casualty	8/15/2000	12/2/2005
Inactive	Omni Indemnity Company	301456	Agent - General Lines	5/30/2000	8/15/2000
Inactive	Omni Indemnity Company	301456	Agent - Property	8/15/2000	12/2/2005
Inactive	Omni Insurance Company	301545	Agent - General Lines	10/21/1987	3/31/2000
Inactive	PAFCO General Insurance Company	301645	Agent - Casualty	8/15/2000	10/4/2001
Inactive	PAFCO General Insurance Company	301645	Agent - General Lines	6/5/1975	8/15/2000
Inactive	PAFCO General Insurance Company	301645	Agent - Property	8/15/2000	10/4/2001
Inactive	PacifiCare Life and Health Insurance Company	301304	Agent - Health	1/25/2007	7/17/2012
Inactive	Permanent General Assurance Corporation	300883	Agent - General Lines	11/10/1995	3/31/1998
Inactive	Plymouth Rock Assurance Preferred Corporation	301834	Agent - Casualty	9/10/2007	1/25/2011
Inactive	Plymouth Rock Assurance Preferred Corporation	301834	Agent - Property	9/10/2007	1/25/2011
Active	Progressive Casualty Insurance Company	300696	Agent - Casualty	6/25/2004
Inactive	Progressive Casualty Insurance Company	300696	Agent - General Lines	5/8/1989	3/31/1998
Active	Progressive Casualty Insurance Company	300696	Agent - Property	6/25/2004
Active	Progressive Northern Insurance Company	301378	Agent - Casualty	5/31/2017
Active	Progressive Northern Insurance Company	301378	Agent - Property	5/31/2017
Inactive	Providence Washington Insurance Company	301160	Agent - General Lines	1/29/1991	3/24/1997
Inactive	Redland Insurance Company	300687	Agent - General Lines	6/30/1993	8/14/1996
Inactive	Royal Neighbors of America	301646	Agent - Life	1/28/2009	12/9/2014
Inactive	Sentinel Insurance Company, Limited	501696	Agent - Casualty	1/17/2005	12/2/2005
Inactive	Sentinel Insurance Company, Limited	501696	Agent - Property	1/17/2005	12/2/2005
Inactive	Shenandoah Life Insurance Company	300130	Agent - Health	9/26/2006	3/31/2009
Inactive	Shenandoah Life Insurance Company	300130	Agent - Life	9/26/2006	12/16/2007
Inactive	South Carolina Insurance Company	300080	Agent - General Lines	4/18/1998	6/5/2000
Inactive	Standard Fire Insurance Company (The)	301068	Agent - General Lines	4/29/1997	10/18/1999
Inactive	Standard Life and Accident Insurance Company	301534	Agent - Health	12/11/2000	1/11/2011
Inactive	Standard Life and Accident Insurance Company	301534	Agent - Life	12/11/2000	1/11/2011
Inactive	The Phoenix Insurance Company	301502	Agent - General Lines	4/29/1997	10/18/1999
Inactive	Time Insurance Company	300683	Agent - Health	10/30/2012	12/20/2014
Inactive	Time Insurance Company	300683	Agent - Life	10/30/2012	12/20/2014
Inactive	Titan Indemnity Company	300556	Agent - Casualty	3/3/2011	6/22/2017
Inactive	Titan Indemnity Company	300556	Agent - Property	3/3/2011	6/22/2017
Inactive	Travelers Casualty and Surety Company	301067	Agent - General Lines	4/29/1997	10/18/1999
Active	Trexis Insurance Corporation	599902	Agent - Casualty	1/10/2005
Active	Trexis One Insurance Corporation	684197	Agent - Casualty	10/15/2008
Inactive	Truck Insurance Exchange	300335	Agent - Casualty	2/4/2008	8/22/2012
Inactive	Truck Insurance Exchange	300335	Agent - Property	2/4/2008	8/22/2012
Inactive	Trumbull Insurance Company	300242	Agent - Casualty	8/15/2000	12/2/2005
Inactive	Trumbull Insurance Company	300242	Agent - General Lines	6/26/1998	8/15/2000
Inactive	Trumbull Insurance Company	300242	Agent - Property	8/15/2000	12/2/2005
Inactive	Twin City Fire Insurance Company	300721	Agent - Casualty	9/15/2003	12/2/2005
Inactive	Twin City Fire Insurance Company	300721	Agent - Property	9/15/2003	12/2/2005
Inactive	Union Bankers Insurance Company	301769	Agent - Health	11/13/2006	12/28/2007
Inactive	United American Insurance Company	300910	Agent - Health	11/16/2005	3/6/2006
Inactive	United American Insurance Company	300910	Agent - Life	11/16/2005	3/6/2006
Active	United Financial Casualty Company	301886	Agent - Casualty	1/4/2017
Active	United Financial Casualty Company	301886	Agent - Property	1/4/2017
Inactive	United Investors Life Insurance Company	301873	Agent - Life	11/16/2005	3/6/2006
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	5/9/2012	6/24/2013
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	5/9/2012	6/24/2013
Inactive	Victoria Fire & Casualty Company	300313	Agent - Casualty	2/8/2007	6/22/2017
Inactive	Victoria Fire & Casualty Company	300313	Agent - Property	2/8/2007	6/22/2017
Inactive	Western Surety Company	300283	Agent - Casualty	8/15/2000	11/14/2001
Inactive	Western Surety Company	300283	Agent - General Lines	8/9/1996	8/15/2000
Active	William Penn Association	300101	Agent - Life	10/30/2008
Inactive	Windhaven National Insurance Company	300094	Agent - Casualty	8/15/2000	12/15/2003
Inactive	Windhaven National Insurance Company	300094	Agent - General Lines	9/27/1993	8/15/2000

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	6/25/1996	2/28/2005
Inactive	Arison Insurance Services, Inc.	401001	Agent - Health	6/25/1996	2/28/2005