DEPARTMENT OF INSURANCE

Affiliations

Name	Shepard, Mitchell Deems	DOIID	361740	NAIC NPN	829613

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Health	10/12/1994	4/1/2013
Inactive	Resident	Agent	Life	6/10/2003	4/1/2013
Inactive	Resident	Agent	Health Maintenance Organization	3/20/1991	7/14/1997
* 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	6/10/2003	4/1/2013
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	6/10/2003	4/1/2013
Inactive	Conseco Health Insurance Company	301725	Agent - Health	10/4/2001	6/17/2002
Inactive	Conseco Health Insurance Company	301725	Agent - Life	10/4/2001	6/17/2002
Inactive	First Colony Life Insurance Company	301179	Agent - Life	3/28/1994	3/31/1997
Inactive	HM Life Insurance Company	301408	Agent - Health	9/24/1991	3/31/1997
Inactive	HM Life Insurance Company	301408	Agent - Life	9/24/1991	3/31/1997
Inactive	Humana Health Plan, Inc.	300142	Agent - Health Maintenance Organization	3/20/1991	7/14/1997
Inactive	John Alden Life Insurance Company	300573	Agent - Health	6/2/1993	3/31/1997
Inactive	John Alden Life Insurance Company	300573	Agent - Life	6/2/1993	3/31/1997
Inactive	John Hancock Life Insurance Company	300821	Agent - Health	6/10/2003	2/1/2005
Inactive	John Hancock Life Insurance Company	300821	Agent - Life	6/10/2003	2/1/2005
Inactive	Kanawha Insurance Company	300127	Agent - Health	11/13/2001	10/14/2002
Inactive	Kanawha Insurance Company	300127	Agent - Life	11/13/2001	10/14/2002
Inactive	LifeUSA Insurance Company	300386	Agent - Health	1/4/2000	8/2/2002
Inactive	LifeUSA Insurance Company	300386	Agent - Life	1/4/2000	8/2/2002
Inactive	Lincoln Benefit Life Company	301110	Agent - Life	4/8/1996	10/29/2001
Inactive	Metropolitan Life Insurance Company	301948	Agent - Health	7/16/1979	3/31/1997
Inactive	Metropolitan Life Insurance Company	301948	Agent - Life	7/16/1979	3/31/1997
Inactive	Midland Life Insurance Company (The)	300310	Agent - Health	12/27/1994	3/31/1997
Inactive	Midland Life Insurance Company (The)	300310	Agent - Life	12/27/1994	3/31/1997
Inactive	Midland National Life Insurance Company	300923	Agent - Health	4/23/1998	3/27/2000
Inactive	Midland National Life Insurance Company	300923	Agent - Life	4/23/1998	3/27/2000
Inactive	National Western Life Insurance Company	301515	Agent - Health	3/22/1996	12/29/1997
Inactive	National Western Life Insurance Company	301515	Agent - Life	3/22/1996	12/29/1997
Inactive	New England Life Insurance Company	300343	Agent - Health	6/10/2003	12/2/2009
Inactive	New England Life Insurance Company	300343	Agent - Life	6/10/2003	12/2/2009
Inactive	Peoples Benefit Life Insurance Company	301895	Agent - Health	6/10/2003	10/9/2003
Inactive	Peoples Benefit Life Insurance Company	301895	Agent - Life	6/10/2003	10/9/2003
Inactive	Security-Connecticut Life Insurance Company	300316	Agent - Health	8/31/1994	3/31/1997
Inactive	Security-Connecticut Life Insurance Company	300316	Agent - Life	8/31/1994	3/31/1997
Inactive	Senior Health Insurance Company of Pennsylvania	300251	Agent - Health	10/22/2001	6/17/2002
Inactive	Senior Health Insurance Company of Pennsylvania	300251	Agent - Life	10/22/2001	6/17/2002
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	10/12/1994	12/7/2005
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	6/10/2003	12/7/2005
Inactive	USG Annuity & Life Company	300457	Agent - Health	6/10/2003	1/1/2004
Inactive	USG Annuity & Life Company	300457	Agent - Life	6/10/2003	1/1/2004
Inactive	Union Security Insurance Company	301844	Agent - Health	10/4/2001	11/25/2002
Inactive	Venerable Insurance and Annuity Company	301006	Agent - Health	1/1/2004	11/6/2006
Inactive	Venerable Insurance and Annuity Company	301006	Agent - Life	1/1/2004	11/6/2006

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Capital Concepts Inc.	399290	Agent - Life	6/10/2003	5/31/2004
Inactive	Capital Concepts Inc.	399290	Agent - Health	6/10/2003	5/31/2004
Inactive	Healthplan Services, Inc.	401230	Agent - Health	8/31/1995	3/31/1997