DEPARTMENT OF INSURANCE

Affiliations

Name	Champine, Alan J	DOIID	618872	NAIC NPN	7935067

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Health	2/20/2013	10/31/2025
Active	Non Resident	Agent	Casualty	10/30/2005	10/31/2025
Active	Non Resident	Agent	Property	10/30/2005	10/31/2025
* 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	08/15/2025	10/31/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	AMEX Assurance Company	301728	Agent - Casualty	11/3/2005	2/8/2007
Inactive	AMEX Assurance Company	301728	Agent - Property	11/3/2005	2/8/2007
Inactive	American Family Connect Property and Casualty Insurance Company	622403	Agent - Casualty	7/2/2008	6/27/2018
Inactive	American Family Connect Property and Casualty Insurance Company	622403	Agent - Health	2/25/2013	9/24/2015
Inactive	American Family Connect Property and Casualty Insurance Company	622403	Agent - Property	7/2/2008	6/27/2018
Inactive	American Modern Home Insurance Company	300791	Agent - Casualty	10/11/2016	12/20/2019
Inactive	American Modern Home Insurance Company	300791	Agent - Property	10/11/2016	12/20/2019
Inactive	American Modern Select Insurance Company	581481	Agent - Casualty	4/22/2016	12/20/2019
Inactive	American Modern Select Insurance Company	581481	Agent - Property	4/22/2016	12/20/2019
Inactive	American Southern Home Insurance Company	626276	Agent - Casualty	11/10/2010	12/20/2019
Inactive	American Southern Home Insurance Company	626276	Agent - Property	11/10/2010	12/20/2019
Active	Care Improvement Plus South Central Insurance Company	799697	Agent - Health	8/18/2021
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	9/13/2012	5/15/2019
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	9/13/2012	5/15/2019
Inactive	Homesite Insurance Company	301139	Agent - Casualty	10/23/2017	5/16/2019
Inactive	Homesite Insurance Company	301139	Agent - Property	10/23/2017	5/16/2019
Inactive	Homesite Insurance Company of the Midwest	874850	Agent - Casualty	10/23/2017	5/16/2019
Inactive	Homesite Insurance Company of the Midwest	874850	Agent - Property	10/23/2017	5/16/2019
Inactive	RLI Insurance Company	301217	Agent - Casualty	1/18/2008	4/23/2019
Inactive	RLI Insurance Company	301217	Agent - Property	1/18/2008	4/23/2019
Active	Sierra Health and Life Insurance Company Inc.	300357	Agent - Health	7/26/2020
Active	UnitedHealthcare Insurance Company	300946	Agent - Health	6/4/2018
Inactive	UnitedHealthcare Insurance Company of America	301552	Agent - Health	6/4/2018	12/21/2018
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	8/6/2019	12/22/2022
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	7/15/2018	12/23/2021
Active	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	6/4/2018

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	American Family Connect Insurance Agency, Inc.	619157	Agent - Property	12/29/2008	3/15/2019
Inactive	American Family Connect Insurance Agency, Inc.	619157	Agent - Casualty	12/29/2008	3/15/2019