DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Passley, Samuel V	DOIID	1088961	NAIC NPN	19506244

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	7/12/2020		9/30/2025
Active	Non Resident	Agent	Life	7/12/2020		9/30/2025
* 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	07/15/2025	09/30/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Care Improvement Plus South Central Insurance Company	799697	Agent - Health	7/17/2022
Inactive	Freedom Life Insurance Company of America	300074	Agent - Health	7/14/2020	8/17/2022
Inactive	Freedom Life Insurance Company of America	300074	Agent - Life	7/14/2020	8/17/2022
Active	UnitedHealthcare Insurance Company	300946	Agent - Health	7/10/2022
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	7/10/2022	12/22/2022
Active	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	7/10/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Ushealth Advisors Llc	713288	Agent - Life	7/14/2020	8/17/2022
Inactive	Ushealth Advisors Llc	713288	Agent - Health	7/14/2020	8/17/2022