DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Champe, David W	DOIID	692145	NAIC NPN	1631695

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	10/24/2008	4/30/2025
Inactive	Non Resident	Agent	Life	10/24/2008	4/30/2025
* 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	Allianz Life Insurance Company of North America	301791	Agent - Life	3/25/2021	11/4/2021
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Health	11/13/2008	11/16/2011
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Life	11/13/2008	11/16/2011
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	12/23/2008	9/8/2010
Inactive	Humana Insurance Company	301104	Agent - Health	12/23/2008	9/9/2010
Inactive	Humana Insurance Company	301104	Agent - Life	12/23/2008	9/9/2010
Inactive	Kanawha Insurance Company	300127	Agent - Health	12/23/2008	9/9/2010
Inactive	Kanawha Insurance Company	300127	Agent - Life	12/23/2008	9/9/2010
Inactive	RiverSource Life Insurance Company	301952	Agent - Health	9/21/2018	11/9/2018
Inactive	RiverSource Life Insurance Company	301952	Agent - Life	9/21/2018	11/9/2018

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Ameriprise Financial Services, LLC	398326	Agent - Life	10/1/2018	11/9/2018
Inactive	Ameriprise Financial Services, LLC	398326	Agent - Health	10/1/2018	11/9/2018
Denied	Designated Agent Company Inc.	681257	Agent - Life
Denied	Designated Agent Company Inc.	681257	Agent - Health
Inactive	Evergreen Ins LLC	979440	Agent - Life	12/15/2017	4/30/2025
Inactive	Evergreen Ins LLC	979440	Agent - Health	12/15/2017	4/30/2025
Inactive	S&T-Evergreen Insurance LLC	659442	Agent - Life	11/13/2008	1/17/2018
Inactive	S&T-Evergreen Insurance LLC	659442	Agent - Health	11/13/2008	1/17/2018