DEPARTMENT OF INSURANCE

Affiliations

Name	Theiss, Mary Donna	DOIID	611888	NAIC NPN	8518292

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Resident	Agent	Casualty	1/14/2022	10/31/2025
Active	Resident	Agent	Life	1/14/2022	10/31/2025
Active	Resident	Agent	Health	1/14/2022	10/31/2025
Active	Resident	Agent	Property	1/14/2022	10/31/2025
* 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	American Fire and Casualty Company	300567	Agent - Casualty	10/7/2008	10/31/2019
Inactive	American Fire and Casualty Company	300567	Agent - Property	10/7/2008	10/31/2019
Inactive	Ameritas Life Insurance Corporation	300126	Agent - Health	2/22/2006	10/31/2019
Inactive	Ameritas Life Insurance Corporation	300126	Agent - Life	2/22/2006	10/31/2019
Inactive	Anthem Life Insurance Company	301209	Agent - Health	5/20/2009	10/31/2019
Inactive	Anthem Life Insurance Company	301209	Agent - Life	5/20/2009	10/31/2019
Inactive	Consolidated Insurance Company	300943	Agent - Casualty	10/7/2008	10/31/2019
Inactive	Consolidated Insurance Company	300943	Agent - Property	10/7/2008	10/31/2019
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	3/21/2009	12/4/2009
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	1/19/2006	12/4/2009
Inactive	Humana Insurance Company	301104	Agent - Health	1/19/2006	12/4/2009
Inactive	Humana Insurance Company	301104	Agent - Life	1/19/2006	12/4/2009
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	1/19/2006	12/4/2009
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	1/19/2006	12/4/2009
Inactive	Indiana Insurance Company	301909	Agent - Casualty	10/7/2008	10/31/2019
Inactive	Indiana Insurance Company	301909	Agent - Property	10/7/2008	10/31/2019
Inactive	Nationwide Assurance Company	300166	Agent - Casualty	7/27/2005	10/31/2019
Inactive	Nationwide General Insurance Company	300603	Agent - Casualty	7/27/2005	10/31/2019
Inactive	Nationwide General Insurance Company	300603	Agent - Property	7/27/2005	10/31/2019
Inactive	Nationwide Life Insurance Company	300495	Agent - Health	10/14/2020	10/31/2021
Inactive	Nationwide Life Insurance Company	300495	Agent - Life	10/14/2020	10/31/2021
Inactive	Nationwide Life and Annuity Insurance Company	300714	Agent - Life	10/14/2020	10/31/2021
Inactive	Nationwide Mutual Fire Insurance Company	301722	Agent - Casualty	7/27/2005	10/31/2019
Inactive	Nationwide Mutual Fire Insurance Company	301722	Agent - Property	7/27/2005	10/31/2019
Active	Nationwide Mutual Insurance Company	301749	Agent - Casualty	2/21/2024
Active	Nationwide Mutual Insurance Company	301749	Agent - Property	2/21/2024
Inactive	Nationwide Property and Casualty Insurance Company	300599	Agent - Casualty	7/27/2005	10/31/2019
Inactive	Nationwide Property and Casualty Insurance Company	300599	Agent - Property	7/27/2005	10/31/2019
Inactive	Netherlands Insurance Company (The)	300339	Agent - Casualty	10/7/2008	10/31/2019
Inactive	Netherlands Insurance Company (The)	300339	Agent - Property	10/7/2008	10/31/2019
Inactive	Ohio Casualty Insurance Company	301492	Agent - Casualty	10/7/2008	10/31/2019
Inactive	Ohio Casualty Insurance Company	301492	Agent - Property	10/7/2008	10/31/2019
Inactive	Ohio Security Insurance Company	300622	Agent - Casualty	10/7/2008	10/31/2019
Inactive	Ohio Security Insurance Company	300622	Agent - Property	10/7/2008	10/31/2019
Inactive	Peerless Indemnity Insurance Company	571682	Agent - Casualty	10/7/2008	10/31/2019
Inactive	Peerless Indemnity Insurance Company	571682	Agent - Property	10/7/2008	10/31/2019
Inactive	Peerless Insurance Company	301910	Agent - Casualty	10/7/2008	10/31/2019
Inactive	Peerless Insurance Company	301910	Agent - Property	10/7/2008	10/31/2019
Active	SAFECO Insurance Company of America	300159	Agent - Casualty	4/12/2024
Active	SAFECO Insurance Company of America	300159	Agent - Property	4/12/2024
Inactive	Victoria Fire & Casualty Company	300313	Agent - Casualty	2/12/2007	10/16/2017
Inactive	Victoria Fire & Casualty Company	300313	Agent - Property	2/12/2007	10/16/2017
Inactive	West American Insurance Company	301112	Agent - Casualty	10/7/2008	10/31/2019
Inactive	West American Insurance Company	301112	Agent - Property	10/7/2008	10/31/2019

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Designated Agent Company Inc.	681257	Agent - Health	5/20/2009	10/31/2019
Inactive	Designated Agent Company Inc.	681257	Agent - Life	5/20/2009	10/31/2019
Active	Donnie R Kays Ins Inc	398073	Agent - Casualty	2/21/2024
Denied	Donnie R Kays Ins Inc	398073	Agent - Health
Denied	Donnie R Kays Ins Inc	398073	Agent - Life
Active	Donnie R Kays Ins Inc	398073	Agent - Property	2/21/2024
Inactive	NBS Insurance Agency Inc	515576	Agent - Casualty	12/17/2008	10/31/2019
Inactive	NBS Insurance Agency Inc	515576	Agent - Property	12/17/2008	10/31/2019