DEPARTMENT OF INSURANCE

Affiliations

Name	Forman, Matthias	DOIID	905171	NAIC NPN	17832061

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Health	11/22/2021	11/30/2022
Inactive	Non Resident	Agent	Personal Lines	1/29/2016	11/30/2022
* 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	11/24/2021	11/30/2022
Inactive	Aetna Health of Ohio Inc.	1065035	Agent - Health	11/24/2021	11/30/2022
Inactive	Aetna Life Insurance Company	301140	Agent - Health	11/24/2021	11/30/2022
Inactive	American Economy Insurance Company	300315	Agent - Personal Lines	5/20/2020	6/24/2020
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	1/12/2022	12/20/2022
Inactive	Anthem Health Plans of New Hampshire, Inc.	944064	Agent - Health	1/12/2022	12/20/2022
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Health	1/12/2022	12/20/2022
Inactive	Bristol West Insurance Company	301655	Agent - Personal Lines	5/19/2020	6/17/2020
Inactive	Care Improvement Plus South Central Insurance Company	799697	Agent - Health	7/21/2022	1/26/2023
Inactive	Compcare Health Services Insurance Corporation	948751	Agent - Health	1/12/2022	12/20/2022
Inactive	Esurance Insurance Company	301072	Agent - Personal Lines	2/4/2016	11/14/2016
Inactive	Esurance Property and Casualty Insurance Company	613279	Agent - Personal Lines	2/4/2016	11/14/2016
Inactive	Farmers Direct Property and Casualty Insurance Company	300957	Agent - Personal Lines	9/10/2020	2/3/2021
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Personal Lines	9/10/2020	2/3/2021
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Personal Lines	5/19/2020	6/17/2020
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	2/23/2022	5/20/2022
Inactive	Humana Insurance Company	301104	Agent - Health	2/16/2022	5/20/2022
Inactive	SAFECO Insurance Company of America	300159	Agent - Personal Lines	5/20/2020	6/24/2020
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Personal Lines	5/20/2020	6/24/2020
Inactive	SilverScript Insurance Company	663526	Agent - Health	11/24/2021	11/30/2022
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	11/22/2021	7/15/2022
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	3/27/2022	1/26/2023
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	3/27/2022	12/22/2022
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	3/27/2022	1/26/2023
Inactive	WellCare Health Insurance Company of Kentucky, Inc.	301478	Agent - Health	12/12/2021	9/21/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Awl Insurance Agency Inc	945504	Agent - Personal Lines	9/10/2020	2/3/2021
Inactive	Esurance Ins Services Inc	709770	Agent - Personal Lines	2/4/2016	11/14/2016