DEPARTMENT OF INSURANCE

Affiliations

Name	Corporate Synergies Group LLC	DOIID	618292	NAIC NPN	8282083

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Health	4/4/2011	3/31/2025
Active	Non Resident	Agent	Life	4/4/2011	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
Agent	01/15/2025	03/31/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Arch Insurance Company	300688	Agent - Health	1/21/2020
Active	CIGNA Health & Life Insurance Company	301783	Agent - Health	6/27/2024
Active	Colonial Life and Accident Insurance Company	300846	Agent - Health	2/24/2012
Active	Colonial Life and Accident Insurance Company	300846	Agent - Life	2/24/2012
Inactive	Humana Insurance Company	301104	Agent - Health	4/20/2006	7/27/2010
Inactive	Humana Insurance Company	301104	Agent - Life	4/20/2006	7/27/2010
Inactive	Metropolitan Life Insurance Company	301948	Agent - Health	8/9/2007	7/27/2010
Inactive	Metropolitan Life Insurance Company	301948	Agent - Life	8/9/2007	7/27/2010
Inactive	National Guardian Life Insurance Company	300596	Agent - Health	1/20/2006	5/11/2008
Inactive	National Guardian Life Insurance Company	300596	Agent - Life	1/20/2006	5/11/2008
Active	Provident Life and Accident Insurance Company	301525	Agent - Health	11/30/2012
Active	Provident Life and Accident Insurance Company	301525	Agent - Life	11/30/2012
Active	UNUM Life Insurance Company of America	300817	Agent - Health	11/30/2012
Active	UNUM Life Insurance Company of America	300817	Agent - Life	11/30/2012
Inactive	Unimerica Insurance Company	563724	Agent - Health	3/21/2008	7/27/2010
Inactive	Unimerica Insurance Company	563724	Agent - Life	3/24/2008	7/27/2010
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	5/1/2006	7/27/2010
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	5/1/2006	7/27/2010
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	5/1/2006	7/27/2010
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	5/1/2006	7/27/2010

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Bloom, Andrew R	1000154	Agent - Health
Denied	Bloom, Andrew R	1000154	Agent - Life
Denied	Fallon, Christopher J	719294	Agent - Health
Denied	Fallon, Christopher J	719294	Agent - Life
Denied	Granfors-Hunt, Liisa	634927	Agent - Health
Denied	Granfors-Hunt, Liisa	634927	Agent - Life
Active	Lisa, Michael T	696054	Agent - Health	4/4/2011
Active	Lisa, Michael T	696054	Agent - Life	4/4/2011
Denied	Mangan, Thomas L	722099	Agent - Health
Denied	Mangan, Thomas L	722099	Agent - Life
Denied	Mccartin, Keith	546667	Agent - Health
Denied	Mccartin, Keith	546667	Agent - Life
Denied	Miller, Jeffrey P	688170	Agent - Health
Denied	Miller, Jeffrey P	688170	Agent - Life
Inactive	Raymond, Eric	621963	Agent - Health	1/25/2007	7/27/2010
Inactive	Raymond, Eric	621963	Agent - Life	1/25/2007	7/27/2010
Denied	Schwartz, Steven A	692611	Agent - Health
Denied	Schwartz, Steven A	692611	Agent - Life
Denied	Ward, Stephanie J	732837	Agent - Health
Denied	Ward, Stephanie J	732837	Agent - Life
Denied	Weiss, Ronald P	688104	Agent - Health
Denied	Weiss, Ronald P	688104	Agent - Life