DEPARTMENT OF INSURANCE

Affiliations

Name	Madon, James Robert	DOIID	368247	NAIC NPN	3102949

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Property	8/15/2000	12/31/2009
Inactive	Resident	Agent	Health Maintenance Organization	6/30/1986	3/1/2001
Inactive	Resident	Agent	General Lines	4/19/1995	8/15/2000
Inactive	Resident	Agent	Life	4/24/1992	12/31/2009
Inactive	Resident	Agent	Casualty	8/15/2000	12/31/2009
Inactive	Resident	Agent	Health	4/24/1992	12/31/2009
AFFIDAVIT ON FILE
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Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Aetna Health Inc.	300694	Agent - Health	7/27/2004	12/31/2007
Inactive	Aetna Health Inc. (PA)	660717	Agent - Health	12/31/2007	12/31/2009
Inactive	Aetna Life Insurance Company	301140	Agent - Health	7/27/2004	12/31/2009
Inactive	Aetna Life Insurance Company	301140	Agent - Life	7/27/2004	12/31/2009
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Health	2/19/2001	3/4/2002
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	2/19/2001	3/4/2002
Inactive	American Fidelity Assurance Company	301004	Agent - Health	5/1/2004	2/3/2006
Inactive	American Fidelity Assurance Company	301004	Agent - Life	5/1/2004	2/3/2006
Inactive	American General Life Insurance Company	301585	Agent - Health	9/29/2004	5/18/2006
Inactive	American General Life Insurance Company	301585	Agent - Life	9/29/2004	5/18/2006
Inactive	American United Life Insurance Company	300498	Agent - Health	4/15/2004	12/31/2009
Inactive	American United Life Insurance Company	300498	Agent - Life	4/15/2004	12/31/2009
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	3/1/2001	9/1/2008
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health Maintenance Organization	6/30/1986	3/1/2001
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Casualty	8/15/2000	12/31/2009
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - General Lines	4/22/1999	8/15/2000
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Health	2/24/1998	4/22/1999
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Property	8/15/2000	12/31/2009
Inactive	Anthem Life Insurance Company	301209	Agent - Health	4/20/1993	9/1/2008
Inactive	Anthem Life Insurance Company	301209	Agent - Life	4/20/1993	9/1/2008
Inactive	BITCO General Insurance Corporation	301305	Agent - General Lines	4/19/1995	3/31/1998
Inactive	CHA HMO, Inc.	300662	Agent - Health	2/25/2003	11/29/2004
Inactive	CHA HMO, Inc.	300662	Agent - Health Maintenance Organization	11/18/1996	3/1/2001
Inactive	Clarica Life Insurance Company - U.S.	300207	Agent - Health	2/15/1995	3/31/1997
Inactive	Clarica Life Insurance Company - U.S.	300207	Agent - Life	2/15/1995	3/31/1997
Inactive	Continental Casualty Company	301019	Agent - Health	5/1/1997	10/29/2002
Inactive	Fidelity & Guaranty Life Insurance Company	301359	Agent - Health	12/30/1996	12/31/2009
Inactive	Fidelity & Guaranty Life Insurance Company	301359	Agent - Life	12/30/1996	3/24/2006
Inactive	First Colony Life Insurance Company	301179	Agent - Life	4/24/2000	1/1/2007
Inactive	Genworth Life and Annuity Insurance Company	301276	Agent - Life	1/1/2007	12/9/2008
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Health	3/9/2005	4/21/2006
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Life	3/9/2005	4/21/2006
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	6/29/2005	12/31/2009
Inactive	Humana Insurance Company	301104	Agent - Health	6/29/2005	12/31/2009
Inactive	Humana Insurance Company	301104	Agent - Life	6/29/2005	12/31/2009
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	6/29/2005	12/31/2009
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	6/29/2005	12/31/2009
Inactive	Insura Property and Casualty Insurance Company	301300	Agent - General Lines	2/20/1997	3/31/1998
Inactive	John Alden Life Insurance Company	300573	Agent - Health	5/17/2004	11/14/2006
Inactive	John Alden Life Insurance Company	300573	Agent - Life	5/17/2004	11/14/2006
Inactive	Kanawha Insurance Company	300127	Agent - Health	4/11/2008	12/31/2009
Inactive	Kanawha Insurance Company	300127	Agent - Life	4/11/2008	12/31/2009
Inactive	LifeUSA Insurance Company	300386	Agent - Health	2/8/1996	3/4/2002
Inactive	LifeUSA Insurance Company	300386	Agent - Life	2/8/1996	3/4/2002
Inactive	Medical Life Insurance Company	300693	Agent - Health	12/31/1997	12/31/2004
Inactive	Medical Life Insurance Company	300693	Agent - Life	12/31/1997	12/31/2004
Inactive	ReliaStar Life Insurance Company	301712	Agent - Health	10/1/2003	8/18/2007
Inactive	ReliaStar Life Insurance Company	301712	Agent - Life	10/1/2003	8/18/2007
Inactive	Security-Connecticut Life Insurance Company	300316	Agent - Health	2/25/1998	10/1/2003
Inactive	Security-Connecticut Life Insurance Company	300316	Agent - Life	2/25/1998	10/1/2003
Inactive	Shelby Insurance Company (The)	300607	Agent - General Lines	2/20/1997	3/31/1998
Inactive	Sun Life Assurance Company of Canada	301811	Agent - Health	9/26/1997	11/3/2009
Inactive	Sun Life Assurance Company of Canada	301811	Agent - Life	9/26/1997	11/3/2009
Inactive	Time Insurance Company	300683	Agent - Health	4/1/2004	5/1/2006
Inactive	Time Insurance Company	300683	Agent - Life	4/1/2004	5/1/2006

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Acordia of Eastern Kentucky-Pikeville Inc.	398199	Agent - General Lines	1/21/1997	11/19/1998
Inactive	Acordia of Eastern Kentucky-Pikeville Inc.	398199	Agent - Life	1/21/1997	11/19/1998
Inactive	Acordia of Eastern Kentucky-Pikeville Inc.	398199	Agent - Health	1/21/1997	11/19/1998
Inactive	Arison Insurance Services, Inc.	401001	Agent - Life	4/24/1992	6/23/2008
Inactive	Arison Insurance Services, Inc.	401001	Agent - Health	4/24/1992	6/23/2008
Inactive	Dental Choice Agency Inc.	398085	Agent - Health	3/28/2002	12/31/2009
Inactive	Healthplan Services, Inc.	401230	Agent - Health	8/31/1995	3/31/1997
Inactive	Wells Fargo Ins Svcs Of Wv Inc	399054	Agent - Life	3/29/1996	2/20/2003
Inactive	Wells Fargo Ins Svcs Of Wv Inc	399054	Agent - Health	3/29/1996	2/20/2003