DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Actuarial Development Services Corporation LLC	DOIID	712572	NAIC NPN	14757079

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	9/1/2009		3/31/2025
Active	Non Resident	Agent	Life	9/1/2009		3/31/2025
* 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	01/15/2025	03/31/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	American Equity Investment Life Insurance Company	300389	Agent - Life	6/8/2010	12/19/2022
Active	Baltimore Life Insurance Company	300286	Agent - Life	10/28/2015
Active	Forethought Life Insurance Company	301407	Agent - Health	11/23/2010
Active	Forethought Life Insurance Company	301407	Agent - Life	11/11/2009
Inactive	Metropolitan Life Insurance Company	301948	Agent - Health	11/21/2009	5/26/2011
Inactive	Metropolitan Life Insurance Company	301948	Agent - Life	11/21/2009	5/26/2011
Active	Nassau Life Insurance Company of Kansas	300667	Agent - Health	10/15/2020
Inactive	Nassau Life and Annuity Company	513671	Agent - Life	4/15/2019	12/28/2022
Inactive	PHL Variable Insurance Company	300525	Agent - Life	11/15/2013	12/2/2020
Active	Sentinel Security Life Insurance Company	935789	Agent - Health	8/11/2022
Active	Sentinel Security Life Insurance Company	935789	Agent - Life	8/11/2022

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Graham, Mark Burnside	638756	Agent - Health	4/12/2018	5/26/2022
Inactive	Graham, Mark Burnside	638756	Agent - Life	4/12/2018	5/26/2022
Active	Graham, Matthew B	640480	Agent - Health	5/26/2022
Active	Graham, Matthew B	640480	Agent - Life	5/26/2022
Inactive	North, Timothy Owen	514133	Agent - Health	9/1/2009	4/13/2018
Inactive	North, Timothy Owen	514133	Agent - Life	9/1/2009	4/13/2018