DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Larson, Kristen	DOIID	658854	NAIC NPN	2090062

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Life	7/5/2007		7/31/2026
Active	Non Resident	Agent	Health	7/5/2007		7/31/2026
* 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	05/15/2024	07/31/2024	06/03/2024	06/03/2024	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	CIGNA Health & Life Insurance Company	301783	Agent - Health	7/31/2015
Active	CIGNA Health & Life Insurance Company	301783	Agent - Life	7/31/2015
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	7/23/2008	12/30/2009
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	7/23/2008	12/30/2009
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	7/23/2008	12/30/2009
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	7/23/2008	12/30/2009

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Mercer Health & Benefits LLC	607080	Agent - Health	1/15/2019
Active	Mercer Health & Benefits LLC	607080	Agent - Life	1/15/2019