DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Grafchik, Adam A	DOIID	677799	NAIC NPN	10606902

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Denied	Resident	Agent	Casualty
Denied	Resident	Agent	Property
Inactive	Resident	Agent	Life	7/22/2008	6/1/2013
Inactive	Resident	Agent	Health	7/22/2008	6/1/2013
* 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	CompBenefits Dental, Inc.	591692	Agent - Health	2/3/2010	6/1/2013
Inactive	CompBenefits Insurance Company	301864	Agent - Health	2/3/2010	11/23/2011
Inactive	CompBenefits Insurance Company	301864	Agent - Life	2/3/2010	11/23/2011
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	3/21/2009	6/1/2013
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	11/19/2008	6/1/2013
Inactive	Humana Insurance Company	301104	Agent - Health	11/19/2008	6/1/2013
Inactive	Humana Insurance Company	301104	Agent - Life	11/19/2008	6/1/2013
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	11/19/2008	6/1/2013
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	11/19/2008	6/1/2013
Inactive	HumanaDental Insurance Company	301457	Agent - Health	11/19/2008	5/13/2013
Inactive	HumanaDental Insurance Company	301457	Agent - Life	11/19/2008	5/13/2013
Inactive	Kanawha Insurance Company	300127	Agent - Health	11/19/2008	6/1/2013
Inactive	Kanawha Insurance Company	300127	Agent - Life	11/19/2008	6/1/2013
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	9/8/2010	6/1/2013
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	9/8/2010	6/1/2013
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	9/8/2010	6/1/2013
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	9/8/2010	6/1/2013

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Assuredpartners Nl, Llc	762387	Agent - Health	9/26/2011	1/30/2012
Inactive	Assuredpartners Nl, Llc	762387	Agent - Life	9/26/2011	1/30/2012
Inactive	Dental Choice Agency Inc.	398085	Agent - Health	10/1/2010	6/1/2013
Inactive	Neace Lukens, Inc.	398909	Agent - Health	5/23/2011	8/19/2012
Inactive	Neace Lukens, Inc.	398909	Agent - Life	5/23/2011	8/19/2012