DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Jacque L	DOIID	311705	NAIC NPN	1493482

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	10/23/1997	1/16/2002
Inactive	Non Resident	Agent	Health	10/23/1997	3/31/2005
Inactive	Non Resident	Agent	Health Maintenance Organization	10/30/1997	3/1/2000
* 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 Health Plans of Kentucky, Inc.	300999	Agent - Health Maintenance Organization	10/30/1997	3/1/2000
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Health	5/8/1998	3/31/2005
Inactive	Anthem Life Insurance Company	301209	Agent - Health	10/23/1997	3/3/2000
Inactive	Anthem Life Insurance Company	301209	Agent - Life	10/23/1997	3/3/2000

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Acordia Senior of The Southeast Inc.	401297	Agent - Health	10/27/1997	2/10/2004
Inactive	Acordia Senior of The Southeast Inc.	401297	Agent - Life	10/27/1997	1/16/2002