DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Champe, David W	DOIID	692145	NAIC NPN	1631695

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	10/24/2008		4/30/2025
Active	Non Resident	Agent	Life	10/24/2008		4/30/2025
* 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	02/15/2025	04/30/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	3/25/2021	11/4/2021
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Health	11/13/2008	11/16/2011
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Life	11/13/2008	11/16/2011
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	12/23/2008	9/8/2010
Inactive	Humana Insurance Company	301104	Agent - Health	12/23/2008	9/9/2010
Inactive	Humana Insurance Company	301104	Agent - Life	12/23/2008	9/9/2010
Inactive	Kanawha Insurance Company	300127	Agent - Health	12/23/2008	9/9/2010
Inactive	Kanawha Insurance Company	300127	Agent - Life	12/23/2008	9/9/2010
Inactive	RiverSource Life Insurance Company	301952	Agent - Health	9/21/2018	11/9/2018
Inactive	RiverSource Life Insurance Company	301952	Agent - Life	9/21/2018	11/9/2018

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Ameriprise Financial Services, LLC	398326	Agent - Life	10/1/2018	11/9/2018
Inactive	Ameriprise Financial Services, LLC	398326	Agent - Health	10/1/2018	11/9/2018
Denied	Designated Agent Company Inc.	681257	Agent - Life
Denied	Designated Agent Company Inc.	681257	Agent - Health
Active	Evergreen Ins LLC	979440	Agent - Life	12/15/2017
Active	Evergreen Ins LLC	979440	Agent - Health	12/15/2017
Inactive	S&T-Evergreen Insurance LLC	659442	Agent - Life	11/13/2008	1/17/2018
Inactive	S&T-Evergreen Insurance LLC	659442	Agent - Health	11/13/2008	1/17/2018