DEPARTMENT OF INSURANCE

Affiliations

Name	Statham, Mark Richard	DOIID	891735	NAIC NPN	17702172

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Life	9/17/2015	3/31/2019
Inactive	Non Resident	Agent	Property	5/15/2017	3/31/2019
Inactive	Non Resident	Agent	Casualty	5/15/2017	3/31/2019
Inactive	Non Resident	Agent	Health	9/17/2015	3/31/2019
* 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	Aetna Health Inc. (PA)	660717	Agent - Health	8/9/2017	3/31/2019
Inactive	Aetna Health and Life Insurance Company	300523	Agent - Health	8/17/2017	2/27/2018
Inactive	Aetna Life Insurance Company	301140	Agent - Health	8/9/2017	3/31/2019
Inactive	Aetna Life Insurance Company	301140	Agent - Life	8/9/2017	3/31/2019
Inactive	American Continental Insurance Company	643130	Agent - Life	8/17/2017	2/27/2018
Inactive	Anthem Life Insurance Company	301209	Agent - Health	8/25/2017	3/31/2019
Inactive	Anthem Life Insurance Company	301209	Agent - Life	8/25/2017	3/31/2019
Inactive	Bristol West Insurance Company	301655	Agent - Casualty	3/14/2018	10/5/2018
Inactive	Bristol West Insurance Company	301655	Agent - Property	3/14/2018	10/5/2018
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	8/17/2017	2/27/2018
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Casualty	4/27/2018	10/4/2018
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Property	4/27/2018	10/4/2018
Inactive	First Health Life & Health Insurance Company	301735	Agent - Health	8/9/2017	3/31/2019
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	4/19/2018	10/5/2018
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	4/19/2018	10/5/2018
Inactive	Grange Indemnity Insurance Company	300793	Agent - Casualty	3/9/2018	1/18/2019
Inactive	Grange Indemnity Insurance Company	300793	Agent - Property	3/9/2018	1/18/2019
Inactive	Grange Insurance Company	300234	Agent - Casualty	3/9/2018	1/18/2019
Inactive	Grange Insurance Company	300234	Agent - Property	3/9/2018	1/18/2019
Inactive	Grange Property & Casualty Insurance Company	601680	Agent - Casualty	3/9/2018	1/18/2019
Inactive	Grange Property & Casualty Insurance Company	601680	Agent - Property	3/9/2018	1/18/2019
Inactive	Homesite Insurance Company	301139	Agent - Casualty	5/19/2017	7/5/2017
Inactive	Homesite Insurance Company	301139	Agent - Property	5/19/2017	7/5/2017
Inactive	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	10/6/2017	10/24/2017
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	10/6/2017	10/24/2017
Inactive	Humana Insurance Company	301104	Agent - Health	10/6/2017	10/24/2017
Inactive	Humana Insurance Company	301104	Agent - Life	10/6/2017	10/24/2017
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	8/23/2017	10/24/2017
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	8/23/2017	10/24/2017
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	10/6/2017	10/24/2017
Inactive	Humana Wisconsin Health Organization Insurance Corporation	830687	Agent - Health	10/6/2017	10/24/2017
Inactive	Loyal American Life Insurance Company	301172	Agent - Health	8/10/2017	1/30/2018
Inactive	Loyal American Life Insurance Company	301172	Agent - Life	8/10/2017	1/30/2018
Inactive	QBE Insurance Corporation	300515	Agent - Casualty	4/12/2018	9/25/2018
Inactive	QBE Insurance Corporation	300515	Agent - Property	4/12/2018	9/25/2018
Inactive	RiverLink Health of Kentucky, Inc.	834205	Agent - Health	9/22/2015	5/4/2017
Inactive	SAFECO Insurance Company of America	300159	Agent - Casualty	3/16/2018	11/10/2018
Inactive	SAFECO Insurance Company of America	300159	Agent - Property	3/16/2018	11/10/2018
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Casualty	3/16/2018	11/10/2018
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Property	3/16/2018	11/10/2018
Inactive	StableView Health, Inc.	834204	Agent - Health	9/22/2015	2/9/2017
Inactive	Trustgard Insurance Company	300104	Agent - Casualty	3/9/2018	1/18/2019
Inactive	Trustgard Insurance Company	300104	Agent - Property	3/9/2018	1/18/2019
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	8/24/2017	3/27/2018
Inactive	UnitedHealthcare Insurance Company of America	301552	Agent - Health	8/24/2017	3/27/2018
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	8/24/2017	3/27/2018

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Designated Agent Company Inc.	681257	Agent - Life	8/29/2017	3/31/2019
Inactive	Designated Agent Company Inc.	681257	Agent - Health	8/29/2017	3/31/2019
Inactive	Insurance Answer Center LLC	694353	Agent - Property	3/9/2018	9/25/2018
Inactive	Insurance Answer Center LLC	694353	Agent - Casualty	3/9/2018	9/25/2018