DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Black, Dawn Marie	DOIID	952653	NAIC NPN	17174768

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Life	4/28/2017		11/30/2025
Active	Non Resident	Agent	Health	4/28/2017		11/30/2025
* 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	09/15/2025	11/30/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Aetna Health Inc. (PA)	660717	Agent - Health	12/22/2020	6/15/2023
Inactive	Aetna Life Insurance Company	301140	Agent - Health	12/22/2020	6/15/2023
Inactive	Freedom Life Insurance Company of America	300074	Agent - Health	5/11/2017	10/19/2023
Inactive	Freedom Life Insurance Company of America	300074	Agent - Life	5/11/2017	10/19/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Ushealth Advisors Llc	713288	Agent - Life	5/11/2017	10/19/2023
Inactive	Ushealth Advisors Llc	713288	Agent - Health	5/11/2017	10/19/2023