DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Concentrix Cvg Cmg Insurance Services Llc	DOIID	811724	NAIC NPN	16145520

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	8/30/2022		3/31/2025
Active	Non Resident	Agent	Property	12/5/2017		3/31/2025
Active	Non Resident	Agent	Life	8/30/2022		3/31/2025
Active	Non Resident	Agent	Casualty	12/5/2017		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
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	8/5/2013	1/12/2022
Inactive	Care Improvement Plus South Central Insurance Company	799697	Agent - Health	8/30/2022	5/18/2023
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	8/30/2022	5/18/2023
Inactive	UnitedHealthcare Insurance Company of America	301552	Agent - Health	9/16/2016	12/20/2018
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	8/30/2022	12/22/2022
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	7/15/2018	12/23/2021
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	5/19/2016	12/19/2016
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	8/30/2022	5/18/2023

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Holley, Jay T	937597	Agent - Health	2/22/2017	1/12/2022
Inactive	Holley, Jay T	937597	Agent - Life	5/3/2017	1/12/2022
Inactive	Kowalczyk, Christine A	828087	Agent - Health	11/7/2014	3/10/2017
Active	Mitchell, Jacob	939971	Agent - Casualty	6/10/2022
Active	Mitchell, Jacob	939971	Agent - Health	8/30/2022
Active	Mitchell, Jacob	939971	Agent - Life	8/30/2022
Active	Mitchell, Jacob	939971	Agent - Property	6/10/2022
Inactive	Stephens, Donald Wayne	391225	Agent - Health	6/5/2013	11/11/2014