DEPARTMENT OF INSURANCE

Affiliations

Name	Chapman, Sandra M	DOIID	322840	NAIC NPN	829150

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Life	9/24/2013		2/28/2027
Active	Resident	Agent	Health	9/24/2013		2/28/2027
Active	Resident	Agent	Casualty	9/24/2013		2/28/2027
Active	Resident	Agent	Property	9/24/2013		2/28/2027
Inactive	Resident	Agent	General Lines	12/19/1997	8/15/2000
Inactive	Resident	Agent	Health Maintenance Organization	11/18/1996	3/1/2001
* 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	12/15/2026	02/28/2027

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Health	8/12/1997	5/16/2000
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	8/12/1997	5/16/2000
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	10/29/1993	9/16/1998
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	10/29/1993	9/16/1998
Inactive	American National Insurance Company	301861	Agent - Health	12/4/1996	7/18/2001
Inactive	American National Insurance Company	301861	Agent - Life	12/4/1996	7/18/2001
Inactive	Augustar Life Assurance Corporation	301113	Agent - Health	7/14/1992	10/17/1997
Inactive	Augustar Life Assurance Corporation	301113	Agent - Life	7/14/1992	10/17/1997
Inactive	Augustar Life Insurance Company	301816	Agent - Health	7/14/1992	10/17/1997
Inactive	Augustar Life Insurance Company	301816	Agent - Life	7/14/1992	10/17/1997
Inactive	CHA HMO, Inc.	300662	Agent - Health Maintenance Organization	11/18/1996	1/4/1999
Inactive	Canada Life Assurance Company	301192	Agent - Health	5/24/1996	12/28/1998
Inactive	Canada Life Assurance Company	301192	Agent - Life	5/24/1996	12/28/1998
Inactive	Companion Life Insurance Company	300191	Agent - Health	11/6/1997	10/18/1999
Inactive	Companion Life Insurance Company	300191	Agent - Life	11/6/1997	10/18/1999
Inactive	Conseco Medical Insurance Company	300719	Agent - Health	1/23/1997	12/15/1998
Inactive	Conseco Medical Insurance Company	300719	Agent - Life	1/23/1997	12/15/1998
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	3/1/2001	7/18/2001
Inactive	Humana Health Plan, Inc.	300142	Agent - Health Maintenance Organization	6/26/2000	3/1/2001
Inactive	Humana Insurance Company	301104	Agent - Health	6/26/2000	7/18/2001
Inactive	Humana Insurance Company	301104	Agent - Life	6/26/2000	7/18/2001
Inactive	Indianapolis Life Insurance Company	301381	Agent - Health	9/23/1997	2/8/1999
Inactive	Indianapolis Life Insurance Company	301381	Agent - Life	9/23/1997	2/8/1999
Inactive	Jackson National Life Insurance Company	300486	Agent - Life	2/8/1995	5/20/1999
Inactive	Kentucky Association of Counties - All Lines Fund	300006	Agent - Casualty	8/15/2000	7/18/2001
Inactive	Kentucky Association of Counties - All Lines Fund	300006	Agent - General Lines	9/3/1998	8/15/2000
Inactive	Kentucky Association of Counties - All Lines Fund	300006	Agent - Property	8/15/2000	7/18/2001
Inactive	LifeUSA Insurance Company	300386	Agent - Health	8/6/1997	5/16/2000
Inactive	LifeUSA Insurance Company	300386	Agent - Life	8/6/1997	5/16/2000
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	12/4/1996	7/14/1997
Inactive	NGL Insurance Company	300596	Agent - Health	7/2/1996	3/31/1999
Inactive	NGL Insurance Company	300596	Agent - Life	7/2/1996	3/31/1999
Inactive	Nationwide Life and Benefits Insurance Company	301045	Agent - Health	5/31/1996	3/1/2001
Inactive	Nationwide Life and Benefits Insurance Company	301045	Agent - Life	5/31/1996	3/1/2001
Inactive	New York Life Insurance Company	300431	Agent - Health	5/2/1996	4/24/2000
Inactive	New York Life Insurance Company	300431	Agent - Life	5/2/1996	4/24/2000
Inactive	Old Line Life Insurance Company of America (The)	301709	Agent - Life	4/17/1997	7/27/1998
Inactive	Protective Life Insurance Company	300638	Agent - Health	1/11/1996	7/18/2001
Inactive	Protective Life Insurance Company	300638	Agent - Life	1/11/1996	7/18/2001
Inactive	Reliance Insurance Company	300785	Agent - Casualty	8/15/2000	6/5/2001
Inactive	Reliance Insurance Company	300785	Agent - General Lines	12/19/1997	8/15/2000
Inactive	Reliance Insurance Company	300785	Agent - Property	8/15/2000	6/5/2001
Inactive	Reliance Surety Company	301224	Agent - General Lines	12/29/1998	8/15/2000
Inactive	Time Insurance Company	300683	Agent - Health	2/19/1997	2/9/2001
Inactive	Time Insurance Company	300683	Agent - Life	2/19/1997	2/9/2001
Inactive	Union Security Insurance Company	301844	Agent - Health	2/10/1997	7/17/1998
Inactive	Union Security Insurance Company	301844	Agent - Life	2/10/1997	7/17/1998
Inactive	United Pacific Insurance Company	300538	Agent - General Lines	12/29/1998	8/15/2000
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	11/17/1999	7/18/2001
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	11/17/1999	7/18/2001
Inactive	Washington National Insurance Company	300587	Agent - Health	4/20/1995	3/31/1997
Inactive	Washington National Insurance Company	300587	Agent - Life	4/20/1995	3/31/1997

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Arison Insurance Services, Inc.	401001	Agent - Life	8/31/1998	7/18/2001
Inactive	Arison Insurance Services, Inc.	401001	Agent - Health	8/31/1998	7/18/2001
Inactive	Kentucky Association Of Counties Ins Agency Inc.	398642	Agent - Health Maintenance Organization	11/15/1999	3/1/2001
Inactive	Kentucky Association Of Counties Ins Agency Inc.	398642	Agent - Life	7/6/1998	7/18/2001
Inactive	Kentucky Association Of Counties Ins Agency Inc.	398642	Agent - Health	7/6/1998	7/18/2001
Inactive	West Kentucky Group Benefits	401049	Agent - Life	12/28/1998	7/18/2001
Inactive	West Kentucky Group Benefits	401049	Agent - Health	12/28/1998	7/18/2001