DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Keith L	DOIID	1058270	NAIC NPN	19257713

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	9/27/2019	11/30/2021
Inactive	Non Resident	Agent	Health	9/27/2019	11/30/2021
* 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	Anthem Life Insurance Company	301209	Agent - Health	5/15/2020	4/27/2021
Inactive	Anthem Life Insurance Company	301209	Agent - Life	5/15/2020	4/27/2021
Inactive	CareSource Kentucky Co.	838179	Agent - Health	12/19/2019	11/30/2021
Inactive	Chesapeake Life Insurance Company (The)	301017	Agent - Health	4/24/2020	5/19/2021
Inactive	Golden Rule Insurance Company	301943	Agent - Health	10/22/2019	9/16/2020
Inactive	Golden Rule Insurance Company	301943	Agent - Life	10/22/2019	9/16/2020

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Designated Agent Company Inc.	681257	Agent - Life	5/15/2020	4/27/2021
Inactive	Designated Agent Company Inc.	681257	Agent - Health	5/15/2020	4/28/2021