DEPARTMENT OF INSURANCE

Affiliations

Name	Sampson, Valenese Renell	DOIID	928983	NAIC NPN	17590019

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Health	9/13/2016	8/31/2019
Inactive	Non Resident	Agent	Life	9/13/2016	8/31/2019
* 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	AXIS Insurance Company	301290	Agent - Health	7/11/2018	10/10/2019
Inactive	Aetna Health Inc. (PA)	660717	Agent - Health	10/11/2016	8/31/2019
Inactive	Aetna Life Insurance Company	301140	Agent - Health	9/30/2016	8/31/2019
Inactive	Aetna Life Insurance Company	301140	Agent - Life	9/30/2016	8/31/2019
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	9/29/2016	2/8/2017
Inactive	CIGNA Health & Life Insurance Company	301783	Agent - Health	7/31/2019	8/31/2019
Inactive	CMFG Life Insurance Company	300929	Agent - Health	9/19/2017	6/25/2018
Inactive	CMFG Life Insurance Company	300929	Agent - Life	9/19/2017	6/25/2018
Inactive	Chesapeake Life Insurance Company (The)	301017	Agent - Health	7/31/2019	8/31/2019
Inactive	Chesapeake Life Insurance Company (The)	301017	Agent - Life	7/31/2019	8/31/2019
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	9/27/2016	7/13/2017
Inactive	First Health Life & Health Insurance Company	301735	Agent - Health	10/11/2016	8/31/2019
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	9/27/2016	7/13/2017
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	9/27/2016	7/13/2017
Inactive	Humana Insurance Company	301104	Agent - Health	9/27/2016	7/13/2017
Inactive	Humana Insurance Company	301104	Agent - Life	9/27/2016	7/13/2017
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	9/27/2016	7/13/2017
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	9/27/2016	7/13/2017
Inactive	Humana Wisconsin Health Organization Insurance Corporation	830687	Agent - Health	10/12/2016	7/13/2017
Inactive	SilverScript Insurance Company	663526	Agent - Health	10/6/2016	8/31/2019
Inactive	Standard Life and Accident Insurance Company	301534	Agent - Health	8/10/2018	8/31/2019
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	9/22/2016	1/4/2017
Inactive	UnitedHealthcare Insurance Company of America	301552	Agent - Health	9/22/2016	1/4/2017
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	9/22/2016	1/4/2017
Inactive	WellCare Prescription Insurance Inc.	654329	Agent - Health	3/7/2019	8/31/2019

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Designated Agent Company Inc.	681257	Agent - Health	9/29/2016	8/31/2019
Inactive	Extend Insurance Services, LLC	625753	Agent - Life	11/16/2016	12/14/2016
Inactive	Extend Insurance Services, LLC	625753	Agent - Health	11/16/2016	12/14/2016