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	Property	8/15/2000		5/31/2025
Active	Resident	Agent	Health	4/7/1987		5/31/2025
Active	Resident	Agent	Casualty	8/15/2000		5/31/2025
Active	Resident	Agent	Life	4/7/1987		5/31/2025
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.

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
Active	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	12/10/2020
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health Maintenance Organization	4/27/1989	3/1/2001
Active	Anthem Life Insurance Company	301209	Agent - Health	12/10/2020
Active	Anthem Life Insurance Company	301209	Agent - Life	12/10/2020
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