DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Black, Samuel Hassell	DOIID	394415	NAIC NPN	374285

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Personal Lines	2/12/2018	10/14/2021
Inactive	Non Resident	Agent	Health	9/18/2019	10/14/2021
Inactive	Non Resident	Agent	Life	9/27/1996	10/25/1996
* 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	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	10/29/2020	10/14/2021
Inactive	Anthem Health Plans of New Hampshire, Inc.	944064	Agent - Health	9/23/2021	10/14/2021
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Health	9/23/2021	10/14/2021
Inactive	Aspen American Insurance Company	301513	Agent - Health	10/28/2019	12/1/2020
Inactive	Compcare Health Services Insurance Corporation	948751	Agent - Health	9/23/2021	10/14/2021
Inactive	Golden Rule Insurance Company	301943	Agent - Health	9/30/2019	10/14/2021
Inactive	LifeShield National Insurance Company	737111	Agent - Health	12/14/2019	12/30/2020
Inactive	Peoples Benefit Life Insurance Company	301895	Agent - Health	9/27/1996	10/25/1996
Inactive	Peoples Benefit Life Insurance Company	301895	Agent - Life	9/27/1996	10/25/1996
Inactive	Progressive Direct Insurance Company	301379	Agent - Personal Lines	2/13/2018	7/9/2018
Inactive	United States Fire Insurance Company	582240	Agent - Health	9/22/2020	10/14/2021
Inactive	Veterans Life Insurance Company	300589	Agent - Health	9/27/1996	10/25/1996
Inactive	Veterans Life Insurance Company	300589	Agent - Life	9/27/1996	10/25/1996

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Health Plan Intermediaries Holdings	786463	Agent - Health	11/12/2019	10/14/2021