DEPARTMENT OF INSURANCE

Affiliations

Name	Churchman Iii, Robert G	DOIID	389261	NAIC NPN	7208589

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Property	8/15/2000	4/1/2015
Inactive	Resident	Agent	General Lines	6/1/1999	8/15/2000
Inactive	Resident	Agent	Health	6/1/1999	4/1/2015
Inactive	Resident	Agent	Life	6/1/1999	4/1/2015
Inactive	Resident	Agent	Casualty	8/15/2000	4/1/2015
Inactive	Resident	Independent Adjuster	Property & Casualty	8/22/2011	3/10/2014
Pending Replacement	Resident	Staff Adjuster	Property & Casualty	6/9/2023		3/31/2025
* 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
Staff Adjuster	01/15/2025	03/31/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	AAA Life Insurance Company	300287	Agent - Health	5/30/2001	7/27/2001
Inactive	AAA Life Insurance Company	300287	Agent - Life	5/30/2001	7/27/2001
Inactive	ACUITY, A Mutual Insurance Company	300095	Agent - Casualty	4/11/2011	4/10/2014
Inactive	ACUITY, A Mutual Insurance Company	300095	Agent - Property	4/11/2011	4/10/2014
Inactive	Aetna Health Inc. (PA)	660717	Agent - Health	10/27/2009	4/1/2015
Inactive	Aetna Life Insurance Company	301140	Agent - Health	10/27/2009	4/1/2015
Inactive	Aetna Life Insurance Company	301140	Agent - Life	10/27/2009	4/1/2015
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Health	1/25/2006	9/7/2011
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	1/25/2006	9/7/2011
Inactive	American Commerce Insurance Company	301665	Agent - Casualty	5/31/2001	11/13/2006
Inactive	American Commerce Insurance Company	301665	Agent - Property	5/31/2001	11/13/2006
Inactive	American Equity Investment Life Insurance Company	300389	Agent - Life	1/12/2006	12/22/2009
Inactive	American General Life Insurance Company	301585	Agent - Health	12/16/2002	1/18/2007
Inactive	American General Life Insurance Company	301585	Agent - Life	12/16/2002	1/18/2007
Inactive	American National General Insurance Company	301944	Agent - Casualty	8/15/2000	5/21/2001
Inactive	American National General Insurance Company	301944	Agent - General Lines	6/1/1999	8/15/2000
Inactive	American National General Insurance Company	301944	Agent - Property	8/15/2000	5/21/2001
Inactive	American National Insurance Company	301861	Agent - Health	6/1/1999	6/4/2001
Inactive	American National Insurance Company	301861	Agent - Life	6/1/1999	6/4/2001
Inactive	American National Property and Casualty Company	300392	Agent - Casualty	8/15/2000	5/21/2001
Inactive	American National Property and Casualty Company	300392	Agent - General Lines	6/1/1999	8/15/2000
Inactive	American National Property and Casualty Company	300392	Agent - Property	8/15/2000	5/21/2001
Inactive	Anthem Life Insurance Company	301209	Agent - Health	10/12/2005	4/1/2015
Inactive	Anthem Life Insurance Company	301209	Agent - Life	10/12/2005	4/1/2015
Inactive	Automobile Insurance Company of Hartford, Connecticut	300630	Agent - Casualty	6/19/2003	10/13/2005
Inactive	Automobile Insurance Company of Hartford, Connecticut	300630	Agent - Property	6/19/2003	10/13/2005
Inactive	Banner Life Insurance Company	301696	Agent - Life	9/30/2002	8/14/2009
Inactive	Charter Oak Fire Insurance Company (The)	301501	Agent - Casualty	6/14/2001	3/1/2003
Inactive	Charter Oak Fire Insurance Company (The)	301501	Agent - Property	6/14/2001	3/1/2003
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	6/24/2008	7/10/2013
Inactive	CompBenefits Insurance Company	301864	Agent - Health	6/24/2008	11/23/2011
Inactive	CompBenefits Insurance Company	301864	Agent - Life	6/24/2008	11/23/2011
Inactive	Dairyland Insurance Company	301370	Agent - Casualty	8/1/2007	7/29/2008
Inactive	Dairyland Insurance Company	301370	Agent - Property	8/1/2007	7/29/2008
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	6/21/2010	7/10/2013
Inactive	Farmers Insurance Exchange	300336	Agent - Casualty	10/24/2005	8/27/2012
Inactive	Farmers Insurance Exchange	300336	Agent - Property	10/24/2005	8/27/2012
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Casualty	3/2/2011	3/27/2014
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Property	3/2/2011	3/27/2014
Inactive	First Colony Life Insurance Company	301179	Agent - Health	1/2/2003	1/1/2007
Inactive	First Colony Life Insurance Company	301179	Agent - Life	1/2/2003	1/1/2007
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	11/13/2012	9/1/2014
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	11/13/2012	9/1/2014
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Casualty	11/13/2012	9/1/2014
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Property	11/13/2012	9/1/2014
Inactive	Foremost Signature Insurance Company	300140	Agent - Casualty	11/13/2012	9/1/2014
Inactive	Foremost Signature Insurance Company	300140	Agent - Property	11/13/2012	9/1/2014
Inactive	Genworth Life and Annuity Insurance Company	301276	Agent - Health	1/1/2007	12/7/2012
Inactive	Genworth Life and Annuity Insurance Company	301276	Agent - Life	1/1/2007	12/7/2012
Inactive	Golden Rule Insurance Company	301943	Agent - Health	1/12/2006	11/10/2008
Inactive	Golden Rule Insurance Company	301943	Agent - Life	1/12/2006	11/10/2008
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	1/31/2007	7/10/2013
Inactive	Humana Insurance Company	301104	Agent - Health	1/31/2007	7/10/2013
Inactive	Humana Insurance Company	301104	Agent - Life	1/31/2007	7/10/2013
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	1/31/2007	7/10/2013
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	1/31/2007	7/10/2013
Inactive	HumanaDental Insurance Company	301457	Agent - Health	11/2/2009	5/13/2013
Inactive	HumanaDental Insurance Company	301457	Agent - Life	11/2/2009	5/13/2013
Inactive	Illinois Mutual Life Insurance Company	301479	Agent - Health	7/19/1999	12/14/2000
Inactive	Illinois Mutual Life Insurance Company	301479	Agent - Life	7/19/1999	12/14/2000
Inactive	John Alden Life Insurance Company	300573	Agent - Health	5/1/2002	11/14/2006
Inactive	John Alden Life Insurance Company	300573	Agent - Life	5/1/2002	11/14/2006
Inactive	Kanawha Insurance Company	300127	Agent - Health	7/12/2012	7/10/2013
Inactive	Kanawha Insurance Company	300127	Agent - Life	7/12/2012	7/10/2013
Inactive	MetLife Investors USA Insurance Company	300845	Agent - Life	2/9/2010	6/20/2014
Inactive	Middlesex Insurance Company	590568	Agent - Casualty	7/18/2007	7/23/2008
Inactive	Middlesex Insurance Company	590568	Agent - Property	7/18/2007	7/23/2008
Inactive	Midland National Life Insurance Company	300923	Agent - Life	8/4/2010	11/22/2010
Inactive	Old Line Life Insurance Company of America (The)	301709	Agent - Health	12/16/2002	3/31/2003
Inactive	Old Line Life Insurance Company of America (The)	301709	Agent - Life	12/16/2002	3/31/2003
Inactive	Physicians Life Insurance Company	300924	Agent - Health	3/11/2004	3/7/2006
Inactive	Physicians Life Insurance Company	300924	Agent - Life	12/20/2001	3/7/2006
Inactive	Physicians Mutual Insurance Company	301084	Agent - Health	12/20/2001	3/7/2006
Inactive	Physicians Mutual Insurance Company	301084	Agent - Life	12/20/2001	10/3/2011
Inactive	Reassure America Life Insurance Company	301902	Agent - Health	11/7/2002	9/3/2004
Inactive	Reassure America Life Insurance Company	301902	Agent - Life	11/7/2002	9/3/2004
Inactive	ReliaStar Life Insurance Company	301712	Agent - Life	3/6/2007	11/2/2007
Inactive	Sentry Insurance Company	300222	Agent - Casualty	7/18/2007	7/23/2008
Inactive	Sentry Insurance Company	300222	Agent - Property	7/18/2007	7/23/2008
Inactive	Sentry Life Insurance Company	301461	Agent - Health	7/25/2007	7/23/2008
Inactive	Sentry Life Insurance Company	301461	Agent - Life	7/25/2007	7/23/2008
Inactive	Standard Fire Insurance Company (The)	301068	Agent - Casualty	6/19/2003	10/13/2005
Inactive	Standard Fire Insurance Company (The)	301068	Agent - Property	6/19/2003	10/13/2005
Inactive	The Phoenix Insurance Company	301502	Agent - Casualty	6/19/2003	10/13/2005
Inactive	The Phoenix Insurance Company	301502	Agent - Property	6/19/2003	10/13/2005
Inactive	Time Insurance Company	300683	Agent - Health	2/10/2003	12/19/2006
Inactive	Time Insurance Company	300683	Agent - Life	2/10/2003	12/19/2006
Inactive	TravCo Insurance Company	301828	Agent - Casualty	6/19/2003	10/19/2005
Inactive	TravCo Insurance Company	301828	Agent - Property	6/19/2003	10/19/2005
Inactive	Travelers Casualty Company of Connecticut	301505	Agent - Casualty	6/19/2003	10/19/2005
Inactive	Travelers Casualty Company of Connecticut	301505	Agent - Property	6/19/2003	10/19/2005
Inactive	Travelers Indemnity Company (The)	301855	Agent - Casualty	6/14/2001	3/1/2003
Inactive	Travelers Indemnity Company (The)	301855	Agent - Property	6/14/2001	3/1/2003
Inactive	Travelers Indemnity Company of America (The)	301093	Agent - Casualty	6/19/2003	10/19/2005
Inactive	Travelers Indemnity Company of America (The)	301093	Agent - Property	6/19/2003	10/19/2005
Inactive	Travelers Indemnity Company of Connecticut (The)	301591	Agent - Casualty	6/14/2001	3/1/2003
Inactive	Travelers Indemnity Company of Connecticut (The)	301591	Agent - Property	6/14/2001	3/1/2003
Inactive	Travelers Property Casualty Insurance Company	301508	Agent - Casualty	6/19/2003	10/19/2005
Inactive	Travelers Property Casualty Insurance Company	301508	Agent - Property	6/19/2003	10/19/2005
Inactive	Truck Insurance Exchange	300335	Agent - Casualty	5/30/2007	8/29/2012
Inactive	Truck Insurance Exchange	300335	Agent - Property	5/30/2007	8/29/2012
Inactive	U.S. Financial Life Insurance Company	301812	Agent - Life	4/2/2003	9/26/2007
Inactive	United American Insurance Company	300910	Agent - Health	7/31/2001	2/5/2002
Inactive	United American Insurance Company	300910	Agent - Life	7/31/2001	2/5/2002
Inactive	United Investors Life Insurance Company	301873	Agent - Life	9/4/2001	2/5/2002
Inactive	Westfield Insurance Company	301950	Agent - Casualty	5/2/2011	10/9/2014
Inactive	Westfield Insurance Company	301950	Agent - Property	5/2/2011	10/9/2014

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	AAA Kentucky Insurance Agency, Inc.	398406	Agent - Life	5/18/2001	6/20/2001
Inactive	AAA Kentucky Insurance Agency, Inc.	398406	Agent - Health	5/18/2001	6/20/2001
Inactive	AAA Kentucky Insurance Agency, Inc.	398406	Agent - Property	5/18/2001	6/20/2001
Inactive	AAA Kentucky Insurance Agency, Inc.	398406	Agent - Casualty	5/18/2001	6/20/2001
Inactive	Arison Insurance Services, Inc.	401001	Agent - Life	10/12/2005	6/21/2008
Inactive	Arison Insurance Services, Inc.	401001	Agent - Health	10/12/2005	6/21/2008
Inactive	Assuredpartners NL, LLC	762387	Agent - Life	9/26/2011	4/1/2015
Inactive	Assuredpartners NL, LLC	762387	Agent - Health	9/26/2011	4/1/2015
Inactive	Assuredpartners NL, LLC	762387	Agent - Property	9/26/2011	10/9/2014
Inactive	Assuredpartners NL, LLC	762387	Agent - Casualty	9/26/2011	10/9/2014
Inactive	Auto-Owners Insurance Company	301480	Independent Adjuster - Property & Casualty	6/27/2013	3/10/2014
Inactive	Auto-Owners Insurance Company	301480	Staff Adjuster - Property & Casualty	3/31/2014	3/31/2023
Inactive	Designated Agent Company Inc.	681257	Agent - Life	6/28/2008	4/1/2015
Inactive	Designated Agent Company Inc.	681257	Agent - Health	6/28/2008	4/1/2015
Inactive	James C Hennessy Inc.	400985	Agent - Life	9/3/2002	1/18/2005
Inactive	James C Hennessy Inc.	400985	Agent - Health	9/3/2002	1/18/2005
Inactive	James C Hennessy Inc.	400985	Agent - Property	8/29/2002	1/18/2005
Inactive	James C Hennessy Inc.	400985	Agent - Casualty	8/29/2002	1/18/2005
Inactive	Medlink Inc	400721	Agent - Life	9/24/2002	4/1/2015
Inactive	Medlink Inc	400721	Agent - Health	9/24/2002	4/1/2015
Inactive	Neace Lukens, Inc.	398909	Agent - Life	2/22/2011	3/31/2014
Inactive	Neace Lukens, Inc.	398909	Agent - Health	2/22/2011	3/31/2014
Inactive	Neace Lukens, Inc.	398909	Agent - Property	2/22/2011	3/31/2014
Inactive	Neace Lukens, Inc.	398909	Agent - Casualty	2/22/2011	3/31/2014
Inactive	Plamp-Keen Agency Inc.	398446	Agent - Life	1/20/2006	3/17/2011
Inactive	Plamp-Keen Agency Inc.	398446	Agent - Health	1/20/2006	3/17/2011
Inactive	Plamp-Keen Agency Inc.	398446	Agent - Property	9/15/2005	3/17/2011
Inactive	Plamp-Keen Agency Inc.	398446	Agent - Casualty	9/15/2005	3/17/2011
Inactive	Preferred Benefits LLC	550000	Agent - Life	5/13/2005	8/6/2013
Inactive	Preferred Benefits LLC	550000	Agent - Health	5/13/2005	8/6/2013