DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Charles A	DOIID	321988	NAIC NPN	43241

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Health	4/7/1987		5/31/2027
Active	Resident	Agent	Property	8/15/2000		5/31/2027
Active	Resident	Agent	Casualty	8/15/2000		5/31/2027
Active	Resident	Agent	Life	4/7/1987		5/31/2027
Inactive	Resident	Agent	General Lines	6/14/1995	8/15/2000
Inactive	Resident	Agent	Health Maintenance Organization	4/27/1989	3/1/2001
* 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	03/15/2025	05/31/2025	04/29/2025	04/29/2025	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	American Benefit Life Insurance Company	301002	Agent - Life	5/18/1994	6/12/1998
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	12/13/2013	10/14/2014
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	12/13/2013	10/14/2014
Inactive	American Heritage Life Insurance Company	300272	Agent - Health	5/21/1999	3/12/2003
Inactive	American Heritage Life Insurance Company	300272	Agent - Life	5/21/1999	3/12/2003
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	12/10/2020	12/23/2024
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health Maintenance Organization	4/27/1989	3/1/2001
Inactive	Anthem Life Insurance Company	301209	Agent - Health	12/10/2020	12/16/2024
Inactive	Anthem Life Insurance Company	301209	Agent - Life	12/10/2020	12/16/2024
Inactive	Aviva Life Insurance Company	301615	Agent - Health	7/8/1991	12/21/2005
Inactive	Aviva Life Insurance Company	301615	Agent - Life	7/8/1991	12/21/2005
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Health	12/17/2003	3/7/2005
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Life	12/17/2003	3/7/2005
Inactive	Bristol West Insurance Company	301655	Agent - Casualty	12/29/2012	12/7/2017
Inactive	Bristol West Insurance Company	301655	Agent - Property	12/29/2012	12/7/2017
Inactive	Chase Insurance Life and Annuity Company	300518	Agent - Health	3/18/1993	4/1/2007
Inactive	Chase Insurance Life and Annuity Company	300518	Agent - Life	3/18/1993	4/1/2007
Inactive	Citizens Security Life Insurance Company	301257	Agent - Health	7/28/1988	2/12/2004
Inactive	Citizens Security Life Insurance Company	301257	Agent - Life	7/28/1988	2/12/2004
Inactive	Conseco Medical Insurance Company	300719	Agent - Health	2/13/1997	12/31/1998
Inactive	Conseco Medical Insurance Company	300719	Agent - Life	2/13/1997	12/31/1998
Inactive	Dairyland Insurance Company	301370	Agent - Casualty	1/6/2012	12/4/2012
Inactive	Dairyland Insurance Company	301370	Agent - Property	1/6/2012	12/4/2012
Inactive	Empower Annuity Insurance Company of America	300259	Agent - Health	5/10/1995	12/6/1996
Inactive	Empower Annuity Insurance Company of America	300259	Agent - Life	5/10/1995	12/6/1996
Inactive	Encova Life Insurance Company	301818	Agent - Health	6/8/1994	3/31/1997
Inactive	Encova Life Insurance Company	301818	Agent - Life	6/8/1994	3/31/1997
Inactive	Everly Life Insurance Company	561641	Agent - Life	9/19/2013	11/14/2018
Inactive	FB Insurance Company (The)	301763	Agent - Casualty	8/15/2000	10/26/2012
Inactive	FB Insurance Company (The)	301763	Agent - General Lines	6/14/1995	8/15/2000
Inactive	FB Insurance Company (The)	301763	Agent - Property	8/15/2000	10/26/2012
Inactive	Family Heritage Life Insurance Company of America	301037	Agent - Health	12/28/2016	3/14/2017
Inactive	Family Heritage Life Insurance Company of America	301037	Agent - Life	12/28/2016	3/14/2017
Active	Federal Life Insurance Company	300945	Agent - Life	4/16/2015
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	12/29/2012	12/7/2017
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	12/29/2012	12/7/2017
Inactive	Freedom Life Insurance Company of America	300074	Agent - Health	3/16/1994	3/31/1997
Inactive	Freedom Life Insurance Company of America	300074	Agent - Life	3/16/1994	3/31/1997
Inactive	Guardian Life Insurance Company of America	301316	Agent - Health	12/17/2003	3/7/2005
Inactive	Guardian Life Insurance Company of America	301316	Agent - Life	12/17/2003	3/7/2005
Active	Independent Mutual Fire Insurance Company	300851	Agent - Casualty	9/10/2024
Active	Independent Mutual Fire Insurance Company	300851	Agent - Property	9/10/2024
Inactive	Investors Life Insurance Company of Indiana	301657	Agent - Health	6/10/1993	3/31/1997
Inactive	Investors Life Insurance Company of Indiana	301657	Agent - Life	6/10/1993	3/31/1997
Inactive	Jefferson-Pilot Life Insurance Company	300379	Agent - Health	8/16/1993	3/22/1996
Inactive	Jefferson-Pilot Life Insurance Company	300379	Agent - Life	8/16/1993	3/22/1996
Inactive	John Alden Life Insurance Company	300573	Agent - Health	5/26/1989	3/24/1997
Inactive	John Alden Life Insurance Company	300573	Agent - Life	5/26/1989	3/24/1997
Inactive	John Hancock Life Insurance Company	300821	Agent - Health	10/25/2005	6/7/2008
Inactive	John Hancock Life Insurance Company	300821	Agent - Life	10/25/2005	6/7/2008
Inactive	Kentucky Farm Bureau Mutual Insurance Company	300570	Agent - Casualty	8/15/2000	10/26/2012
Inactive	Kentucky Farm Bureau Mutual Insurance Company	300570	Agent - General Lines	6/14/1995	8/15/2000
Inactive	Kentucky Farm Bureau Mutual Insurance Company	300570	Agent - Property	8/15/2000	10/26/2012
Inactive	Legacy Life Insurance Company	301356	Agent - Health	7/5/1989	9/28/1990
Inactive	Legacy Life Insurance Company	301356	Agent - Life	7/5/1989	9/28/1990
Inactive	Lincoln Heritage Life Insurance Company	500016	Agent - Health	2/29/2016	10/11/2017
Inactive	Lincoln Heritage Life Insurance Company	500016	Agent - Life	2/29/2016	10/11/2017
Inactive	Modern Woodmen of America	301213	Agent - Life	5/19/2014	12/7/2016
Inactive	Old American Insurance Company	300762	Agent - Health	11/29/2016	2/2/2019
Inactive	Old American Insurance Company	300762	Agent - Life	11/29/2016	2/2/2019
Inactive	Physicians Life Insurance Company	300924	Agent - Life	3/16/2017	8/1/2017
Inactive	Physicians Mutual Insurance Company	301084	Agent - Health	3/16/2017	8/1/2017
Inactive	Protective Life Insurance Company	300638	Agent - Health	4/1/2007	12/24/2009
Inactive	Protective Life Insurance Company	300638	Agent - Life	4/1/2007	12/24/2009
Active	Security National Life Insurance Company	569786	Agent - Life	12/15/2020
Inactive	Settlers Life Insurance Company	300189	Agent - Health	4/12/1995	3/31/1997
Inactive	Settlers Life Insurance Company	300189	Agent - Life	4/12/1995	3/31/1997
Inactive	Southern Farm Bureau Life Insurance Company	300909	Agent - Health	6/14/1995	10/23/2012
Inactive	Southern Farm Bureau Life Insurance Company	300909	Agent - Life	6/14/1995	10/23/2012
Inactive	Southwestern Life Insurance Company	301343	Agent - Life	9/27/1993	5/2/2003
Inactive	Time Insurance Company	300683	Agent - Health	2/26/1992	11/13/1996
Inactive	Time Insurance Company	300683	Agent - Life	2/26/1992	11/13/1996
Inactive	Transamerica Life Insurance Company	300571	Agent - Health	11/8/2016	1/19/2021
Inactive	Transamerica Life Insurance Company	300571	Agent - Life	11/8/2016	1/19/2021
Inactive	Transamerica Premier Life Insurance Company	300558	Agent - Health	6/28/2017	10/1/2020
Inactive	Transamerica Premier Life Insurance Company	300558	Agent - Life	6/28/2017	10/1/2020
Inactive	Trinity Life Insurance Company	552459	Agent - Life	10/14/2015	9/25/2019
Inactive	Victoria Fire & Casualty Company	300313	Agent - Casualty	5/2/2011	6/23/2017
Inactive	Victoria Fire & Casualty Company	300313	Agent - Property	5/2/2011	6/23/2017
Inactive	Washington National Insurance Company	300587	Agent - Health	2/18/1994	3/31/1997
Inactive	Washington National Insurance Company	300587	Agent - Life	2/18/1994	3/31/1997
Inactive	Western and Southern Life Insurance Company	301744	Agent - Health	7/21/2014	3/31/2015
Inactive	Western and Southern Life Insurance Company	301744	Agent - Life	7/21/2014	3/31/2015
Inactive	Western-Southern Life Assurance Company	301590	Agent - Health	7/21/2014	3/31/2015
Inactive	Western-Southern Life Assurance Company	301590	Agent - Life	7/21/2014	3/31/2015
Inactive		300277	Agent - Health	11/21/1996	9/14/1999
Inactive		300277	Agent - Life	11/21/1996	9/14/1999

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Charles A Clark Inc.	400796	Agent - Life	6/16/1999	3/31/2020
Inactive	Charles A Clark Inc.	400796	Agent - Health	6/16/1999	3/31/2020
Inactive	Charles A Clark Inc.	400796	Agent - General Lines	6/16/1999	8/15/2000
Inactive	Charles A Clark Inc.	400796	Agent - Property	8/15/2000	3/31/2020
Inactive	Charles A Clark Inc.	400796	Agent - Casualty	8/15/2000	3/31/2020
Inactive	Designated Agent Company Inc.	681257	Agent - Life	9/8/2013	12/10/2020
Inactive	Designated Agent Company Inc.	681257	Agent - Health	9/8/2013	12/10/2020
Inactive	Healthplan Services, Inc.	401230	Agent - Health	8/31/1995	3/31/1997
Inactive	Insurance One Inc.	399840	Agent - Life	10/21/1991	5/31/2004
Inactive	Insurance One Inc.	399840	Agent - Health	10/21/1991	5/31/2004
Inactive	Kentucky Farm Bureau Insurance Agency LLC	399619	Agent - Life	6/21/1995	10/24/2012
Inactive	Kentucky Farm Bureau Insurance Agency LLC	399619	Agent - Health	6/21/1995	10/24/2012
Inactive	Kentucky Farm Bureau Insurance Agency LLC	399619	Agent - General Lines	6/21/1995	8/15/2000
Inactive	Kentucky Farm Bureau Insurance Agency LLC	399619	Agent - Property	8/15/2000	10/24/2012
Inactive	Kentucky Farm Bureau Insurance Agency LLC	399619	Agent - Casualty	8/15/2000	10/24/2012
Inactive	Southern Capital Brokerage Co LLC	577403	Agent - Life	9/7/2004	3/31/2007
Inactive	Southern Capital Brokerage Co LLC	577403	Agent - Health	9/7/2004	3/31/2007