DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Jay M	DOIID	322857	NAIC NPN	7169100

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Life	5/16/2002	7/1/2006
Inactive	Resident	Agent	Health	9/18/1997	7/1/2006
* 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	Allianz Life Insurance Company of North America	301791	Agent - Health	6/20/2002	1/29/2005
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	6/20/2002	1/29/2005
Inactive	American Pioneer Life Insurance Company	301782	Agent - Health	11/8/2002	3/14/2003
Inactive	American Pioneer Life Insurance Company	301782	Agent - Life	11/8/2002	3/14/2003
Inactive	Equitable Life Insurance Company of Iowa	301633	Agent - Life	6/6/2002	1/1/2004
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	5/30/2002	3/7/2005
Inactive	Humana Insurance Company	301104	Agent - Health	5/30/2002	3/7/2005
Inactive	Humana Insurance Company	301104	Agent - Life	5/30/2002	3/7/2005
Inactive	Jackson National Life Insurance Company	300486	Agent - Life	6/17/2002	2/14/2003
Inactive	John Hancock Life Insurance Company	300821	Agent - Health	10/15/2002	2/2/2005
Inactive	John Hancock Life Insurance Company	300821	Agent - Life	10/15/2002	2/2/2005
Inactive	John Hancock Variable Life Insurance Company	301914	Agent - Health	10/15/2002	12/1/2005
Inactive	John Hancock Variable Life Insurance Company	301914	Agent - Life	10/15/2002	2/2/2005
Inactive	Protected Home Mutual Life Insurance Company	301399	Agent - Health	7/1/2002	4/28/2003
Inactive	Protected Home Mutual Life Insurance Company	301399	Agent - Life	7/1/2002	4/28/2003
Inactive	ReliaStar Life Insurance Company	301712	Agent - Health	6/12/2002	7/1/2006
Inactive	ReliaStar Life Insurance Company	301712	Agent - Life	6/12/2002	7/1/2006
Inactive	Security Life of Denver Insurance Company	300648	Agent - Life	6/12/2002	3/1/2005
Inactive	Security-Connecticut Life Insurance Company	300316	Agent - Health	6/10/2002	10/1/2003
Inactive	Security-Connecticut Life Insurance Company	300316	Agent - Life	6/10/2002	10/1/2003
Inactive	Southland Life Insurance Company	301175	Agent - Health	6/10/2002	9/17/2004
Inactive	Southland Life Insurance Company	301175	Agent - Life	6/10/2002	9/17/2004
Inactive	State Mutual Insurance Company	300359	Agent - Health	6/28/2002	12/15/2003
Inactive	Sterling Life Insurance Company	301947	Agent - Health	3/17/2003	10/20/2003
Inactive	Sterling Life Insurance Company	301947	Agent - Life	3/17/2003	10/20/2003
Inactive	USG Annuity & Life Company	300457	Agent - Life	6/3/2002	1/1/2004
Inactive	United American Insurance Company	300910	Agent - Health	9/18/1997	6/17/2002
Inactive	United American Insurance Company	300910	Agent - Life	5/16/2002	6/17/2002
Inactive	Venerable Insurance and Annuity Company	301006	Agent - Life	1/1/2004	7/1/2006
Inactive	Wellpoint Life and Health Insurance Company	300469	Agent - Health	11/8/2002	6/1/2003
Inactive	Wellpoint Life and Health Insurance Company	300469	Agent - Life	11/8/2002	6/1/2003
Inactive	Western and Southern Life Insurance Company	301744	Agent - Health	3/26/2004	9/23/2004
Inactive	Western and Southern Life Insurance Company	301744	Agent - Life	3/26/2004	9/23/2004
Inactive	Western-Southern Life Assurance Company	301590	Agent - Health	3/26/2004	9/23/2004
Inactive	Western-Southern Life Assurance Company	301590	Agent - Life	3/26/2004	9/23/2004

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Humana MarketPOINT Inc.	398092	Agent - Health	5/13/2002	2/4/2004
Inactive	Humana MarketPOINT Inc.	398092	Agent - Life	5/31/2002	2/4/2004
Inactive	Planchoice Inc.	400482	Agent - Health	3/5/2003	7/1/2006
Inactive	Planchoice Inc.	400482	Agent - Life	3/5/2003	7/1/2006