DEPARTMENT OF INSURANCE

Affiliations

Name	Champ, Kelly	DOIID	920757	NAIC NPN	17955835

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Life	8/28/2021	12/31/2023
Inactive	Non Resident	Agent	Health	8/28/2021	12/31/2023
* 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	9/1/2022	12/31/2023
Inactive	Aetna Health of Ohio Inc.	1065035	Agent - Health	9/1/2022	12/31/2023
Inactive	Aetna Life Insurance Company	301140	Agent - Health	9/1/2022	12/31/2023
Inactive	Aetna Life Insurance Company	301140	Agent - Life	9/1/2022	12/31/2023
Inactive	American Heritage Life Insurance Company	300272	Agent - Health	9/21/2017	3/29/2019
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	8/18/2022	3/1/2023
Inactive	Anthem Health Plans of New Hampshire, Inc.	944064	Agent - Health	8/18/2022	3/1/2023
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Health	8/18/2022	3/1/2023
Inactive	Care Improvement Plus South Central Insurance Company	799697	Agent - Health	9/14/2022	11/22/2022
Inactive	Compcare Health Services Insurance Corporation	948751	Agent - Health	8/18/2022	3/1/2023
Inactive	Continental American Insurance Company	301700	Agent - Health	9/21/2017	3/29/2019
Inactive	Nationwide Life Insurance Company	300495	Agent - Health	10/9/2017	3/22/2019
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	10/10/2017	12/31/2019
Inactive	Sierra Health and Life Insurance Company Inc.	300357	Agent - Health	7/11/2016	8/26/2016
Inactive	SilverScript Insurance Company	663526	Agent - Health	9/1/2022	12/31/2023
Inactive	Starmount Life Insurance Company	628031	Agent - Health	10/10/2017	12/31/2019
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	10/10/2017	12/31/2019
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	9/14/2022	11/22/2022
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	9/14/2022	11/22/2022
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	7/11/2016	8/26/2016
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	9/14/2022	11/22/2022
Inactive	Unum Insurance Company	301499	Agent - Health	2/28/2019	12/31/2019
Inactive	WellCare Health Insurance Company of Kentucky, Inc.	301478	Agent - Health	11/4/2019	12/31/2019
Inactive	WellCare Prescription Insurance Inc.	654329	Agent - Health	11/4/2019	12/31/2019

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Mercer Health & Benefits Administration LLC	656414	Agent - Health	1/28/2019	12/31/2019
Inactive	Trubridge Inc	717747	Agent - Health	8/18/2022	12/5/2022
Inactive	Trubridge Inc	717747	Agent - Life	9/1/2022	12/21/2022