DEPARTMENT OF INSURANCE

Affiliations

Name	Custom Benefit Programs Inc DBA : Univers Workplace Solutions	DOIID	630774	NAIC NPN	1992094

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Casualty	12/4/2009	3/31/2026
Active	Non Resident	Agent	Health	8/16/2006	3/31/2026
Active	Non Resident	Agent	Property	12/4/2009	3/31/2026
Active	Non Resident	Agent	Life	8/16/2006	3/31/2026
* 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	01/15/2026	03/31/2026

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	ACE Property and Casualty Insurance Company	300520	Agent - Health	12/30/2019
Active	Aetna Health Inc. (PA)	660717	Agent - Health	9/23/2022
Active	Aetna Life Insurance Company	301140	Agent - Health	9/23/2022
Active	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	11/2/2009
Active	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	11/2/2009
Active	American Heritage Life Insurance Company	300272	Agent - Health	11/11/2021
Active	American Heritage Life Insurance Company	300272	Agent - Life	11/11/2021
Active	American Pet Insurance Company, Inc.	301240	Agent - Casualty	1/7/2022
Active	American Pet Insurance Company, Inc.	301240	Agent - Property	1/7/2022
Active	Boston Mutual Life Insurance Company	300143	Agent - Health	5/5/2010
Active	Boston Mutual Life Insurance Company	300143	Agent - Life	5/5/2010
Active	Colonial Life and Accident Insurance Company	300846	Agent - Health	11/2/2009
Active	Colonial Life and Accident Insurance Company	300846	Agent - Life	11/2/2009
Active	Combined Insurance Company of America	301472	Agent - Health	5/14/2015
Active	Combined Insurance Company of America	301472	Agent - Life	5/14/2015
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	12/10/2012	12/10/2018
Active	Continental American Insurance Company	301700	Agent - Health	9/29/2008
Active	Continental American Insurance Company	301700	Agent - Life	9/29/2008
Inactive	Continental General Insurance Company	300691	Agent - Health	8/9/2018	1/25/2019
Inactive	Continental General Insurance Company	300691	Agent - Life	8/9/2018	1/25/2019
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	12/10/2012	12/10/2018
Inactive	HM Life Insurance Company	301408	Agent - Health	6/3/2008	4/24/2018
Inactive	HM Life Insurance Company	301408	Agent - Life	6/3/2008	4/24/2018
Active	Hartford Life and Accident Insurance Company	300878	Agent - Health	2/4/2021
Active	Hartford Life and Accident Insurance Company	300878	Agent - Life	2/4/2021
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	12/10/2012	12/10/2018
Inactive	Humana Insurance Company	301104	Agent - Health	12/10/2012	12/10/2018
Inactive	Humana Insurance Company	301104	Agent - Life	12/10/2012	12/10/2018
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	12/10/2012	12/10/2018
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	12/10/2012	12/10/2018
Active	Independence American Insurance Company	524747	Agent - Casualty	6/9/2023
Active	Independence American Insurance Company	524747	Agent - Property	6/9/2023
Inactive	Kanawha Insurance Company	300127	Agent - Health	9/11/2008	8/9/2018
Inactive	Kanawha Insurance Company	300127	Agent - Life	9/11/2008	8/9/2018
Active	Life Insurance Company of North America	300711	Agent - Health	9/30/2019
Active	Life Insurance Company of North America	300711	Agent - Life	9/30/2019
Active	Lincoln National Life Insurance Company (The)	301382	Agent - Health	6/26/2023
Active	Lincoln National Life Insurance Company (The)	301382	Agent - Life	6/26/2023
Active	Metropolitan Life Insurance Company	301948	Agent - Health	7/5/2022
Active	Metropolitan Life Insurance Company	301948	Agent - Life	7/5/2022
Active	Metropolitan Tower Life Insurance Company	300322	Agent - Health	5/1/2023
Active	Metropolitan Tower Life Insurance Company	300322	Agent - Life	5/1/2023
Active	Provident Life and Accident Insurance Company	301525	Agent - Health	11/6/2006
Active	Provident Life and Accident Insurance Company	301525	Agent - Life	11/6/2006
Active	Prudential Insurance Company of America	300784	Agent - Health	11/11/2020
Active	Prudential Insurance Company of America	300784	Agent - Life	11/11/2020
Active	ReliaStar Life Insurance Company	301712	Agent - Health	12/4/2023
Active	ReliaStar Life Insurance Company	301712	Agent - Life	12/4/2023
Inactive	ReliaStar Life Insurance Company of New York	301018	Agent - Health	10/8/2007	11/9/2009
Inactive	ReliaStar Life Insurance Company of New York	301018	Agent - Life	10/8/2007	11/9/2009
Active	Starmount Life Insurance Company	628031	Agent - Health	10/8/2021
Active	Transamerica Life Insurance Company	300571	Agent - Health	12/16/2009
Active	Transamerica Life Insurance Company	300571	Agent - Life	12/16/2009
Active	Trustmark Insurance Company	300317	Agent - Health	4/1/2009
Active	Trustmark Insurance Company	300317	Agent - Life	4/1/2009
Active	UNUM Life Insurance Company of America	300817	Agent - Health	11/6/2006
Active	UNUM Life Insurance Company of America	300817	Agent - Life	11/6/2006
Active	United States Fire Insurance Company	582240	Agent - Casualty	9/13/2018
Active	United States Fire Insurance Company	582240	Agent - Property	9/13/2018
Active	Unum Insurance Company	301499	Agent - Health	10/8/2021
Active	Unum Insurance Company	301499	Agent - Life	10/8/2021

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Alvarado, Ivelisse Rivera	1171906	Agent - Health	8/24/2023	2/2/2024
Inactive	Alvarado, Ivelisse Rivera	1171906	Agent - Life	8/24/2023	2/2/2024
Active	Ballard, Tawni M	862382	Agent - Health	2/16/2022
Active	Ballard, Tawni M	862382	Agent - Life	2/16/2022
Inactive	Borajkiewicz, Jeffrey J	881828	Agent - Health	3/24/2022	4/10/2024
Inactive	Borajkiewicz, Jeffrey J	881828	Agent - Life	3/24/2022	4/10/2024
Active	Campana, William W	1138292	Agent - Health	5/22/2023
Active	Campana, William W	1138292	Agent - Life	5/22/2023
Active	Carrico, Ronald Ray	579902	Agent - Health	3/24/2022
Active	Carrico, Ronald Ray	579902	Agent - Life	3/24/2022
Inactive	Chance, Julia Yurievna	769538	Agent - Health	2/16/2022	7/29/2024
Active	Colton, Timothy M	629175	Agent - Health	3/29/2022
Active	Colton, Timothy M	629175	Agent - Life	3/29/2022
Active	Dapelo, Annemarie	1140833	Agent - Health	2/16/2022
Inactive	Dapelo, Annemarie	1140833	Agent - Life	2/16/2022	7/23/2024
Inactive	Farlow, Daniel Jay	789293	Agent - Health	2/13/2024	7/17/2024
Inactive	Farlow, Daniel Jay	789293	Agent - Life	2/13/2024	7/17/2024
Inactive	Frye, Warren R	306701	Agent - Health	3/29/2022	7/25/2024
Inactive	Frye, Warren R	306701	Agent - Life	3/29/2022	7/25/2024
Active	Gitelson, Leonard Roy	882601	Agent - Health	3/24/2022
Active	Gitelson, Leonard Roy	882601	Agent - Life	3/24/2022
Active	Gruvman, Gabriel Omar	319564	Agent - Health	3/24/2022
Active	Gruvman, Gabriel Omar	319564	Agent - Life	3/24/2022
Inactive	Hand, Claudia Louise	314820	Agent - Health	3/24/2022	5/1/2025
Inactive	Hand, Claudia Louise	314820	Agent - Life	3/24/2022	5/1/2025
Pending Replacement	Hiltner, Eugenia S	1141117	Agent - Health	4/27/2023
Pending Replacement	Hiltner, Eugenia S	1141117	Agent - Life	4/27/2023
Inactive	Jaspe, Jose	883914	Agent - Health	2/16/2022	8/31/2023
Inactive	Jaspe, Jose	883914	Agent - Life	2/16/2022	8/31/2023
Active	Johnson, Glenn I	682142	Agent - Health	3/24/2022
Active	Johnson, Glenn I	682142	Agent - Life	3/24/2022
Active	Kennedy, Brian D	833022	Agent - Health	2/26/2021
Active	Kennedy, Brian D	833022	Agent - Life	2/26/2021
Active	Ladner, Theresa Dianne	331768	Agent - Health	3/24/2022
Active	Ladner, Theresa Dianne	331768	Agent - Life	3/24/2022
Active	Lago, Enrique	751233	Agent - Health	2/16/2022
Active	Lago, Enrique	751233	Agent - Life	2/16/2022
Inactive	Melhado, Michelle	882895	Agent - Health	1/18/2024	3/22/2024
Inactive	Melhado, Michelle	882895	Agent - Life	1/18/2024	3/22/2024
Inactive	Mercado, Ana Rita	602565	Agent - Health	3/11/2020	6/13/2024
Inactive	Mercado, Ana Rita	602565	Agent - Life	3/11/2020	6/13/2024
Active	Merrill, Cheryl Ann	881944	Agent - Health	3/24/2022
Active	Merrill, Cheryl Ann	881944	Agent - Life	3/24/2022
Inactive	Miano, Linda M	783014	Agent - Health	2/16/2022	6/13/2024
Inactive	Miano, Linda M	783014	Agent - Life	2/16/2022	6/13/2024
Active	Middleman, Stephen E	776362	Agent - Health	3/11/2020
Active	Middleman, Stephen E	776362	Agent - Life	3/11/2020
Active	Morano, Gregory J	309386	Agent - Casualty	3/10/2023
Active	Morano, Gregory J	309386	Agent - Health	10/28/2021
Active	Morano, Gregory J	309386	Agent - Life	10/28/2021
Active	Morano, Gregory J	309386	Agent - Property	3/10/2023
Inactive	Oddo, Adam Dean	1141320	Agent - Health	5/22/2023	6/17/2025
Inactive	Oddo, Adam Dean	1141320	Agent - Life	5/22/2023	6/17/2025
Active	Pantalone, Jo A	360158	Agent - Health	3/24/2022
Active	Pantalone, Jo A	360158	Agent - Life	3/24/2022
Active	Pantalone, Louis J	310251	Agent - Casualty	12/4/2009
Active	Pantalone, Louis J	310251	Agent - Health	8/16/2006
Active	Pantalone, Louis J	310251	Agent - Life	8/16/2006
Active	Pantalone, Louis J	310251	Agent - Property	12/4/2009
Inactive	Perdue, Tina Martin	802346	Agent - Health	3/11/2020	10/31/2023
Inactive	Perdue, Tina Martin	802346	Agent - Life	3/11/2020	10/31/2023
Active	Piela, Greg Scott	841564	Agent - Health	2/16/2022
Active	Piela, Greg Scott	841564	Agent - Life	2/16/2022
Active	Rabinowitz, Steven	1141558	Agent - Health	6/17/2025
Active	Rabinowitz, Steven	1141558	Agent - Life	6/17/2025
Active	Richman, Melissa D	751228	Agent - Health	2/25/2019
Active	Richman, Melissa D	751228	Agent - Life	2/25/2019
Active	Royston, James R	766626	Agent - Health	7/30/2024
Active	Royston, James R	766626	Agent - Life	7/30/2024
Active	Sacco, Craig Louis	366250	Agent - Health	3/24/2022
Active	Sacco, Craig Louis	366250	Agent - Life	3/24/2022
Inactive	Santiago, Maribel M	1179128	Agent - Health	8/22/2023	5/1/2025
Inactive	Santiago, Maribel M	1179128	Agent - Life	8/22/2023	5/1/2025
Active	Schwenk, Debra Robin	610443	Agent - Health	3/24/2022
Active	Schwenk, Debra Robin	610443	Agent - Life	3/24/2022
Active	Scott-Graham, Chanel L	636903	Agent - Health	3/11/2020
Active	Scott-Graham, Chanel L	636903	Agent - Life	3/11/2020
Active	Shepard, Jeanne Howard	1042498	Agent - Health	5/22/2023
Active	Shepard, Jeanne Howard	1042498	Agent - Life	5/22/2023
Inactive	Stewart, Laura B	1152733	Agent - Health	2/16/2022	7/24/2024
Inactive	Stewart, Laura B	1152733	Agent - Life	2/16/2022	7/24/2024
Active	Valentino, Deena Catherine	1152336	Agent - Health	9/25/2023
Active	Valentino, Deena Catherine	1152336	Agent - Life	9/25/2023
Active	Wagner, David Allen	590127	Agent - Health	3/11/2020
Active	Wagner, David Allen	590127	Agent - Life	3/11/2020
Active	Waller, Claudia	818796	Agent - Health	2/26/2021
Active	Waller, Claudia	818796	Agent - Life	2/26/2021
Active	Walton, Brenda Jane	802324	Agent - Health	3/11/2020
Active	Walton, Brenda Jane	802324	Agent - Life	3/11/2020
Inactive	Wilson, Zachary R	724658	Agent - Health	3/11/2020	7/17/2023
Inactive	Wilson, Zachary R	724658	Agent - Life	3/11/2020	7/17/2023