DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, John Harvey	DOIID	371097	NAIC NPN	2223211

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Life	3/2/1994	8/31/2018
Inactive	Non Resident	Agent	Health	3/2/1994	8/31/2018
Inactive	Non Resident	Agent	Health Maintenance Organization	11/5/1987	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	Allianz Life Insurance Company of North America	301791	Agent - Health	3/2/1994	4/7/2004
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	3/2/1994	4/7/2004
Inactive	American United Life Insurance Company	300498	Agent - Health	7/8/2004	8/31/2018
Inactive	American United Life Insurance Company	300498	Agent - Life	7/8/2004	8/31/2018
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Health	11/29/2004	12/21/2011
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Life	11/29/2004	12/21/2011
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	3/21/2009	7/20/2012
Inactive	Fort Wayne Health & Casualty Insurance Company	301572	Agent - Health	1/23/1998	12/22/2004
Inactive	Guardian Life Insurance Company of America	301316	Agent - Health	11/29/2004	8/31/2018
Inactive	Guardian Life Insurance Company of America	301316	Agent - Life	11/29/2004	8/31/2018
Inactive	Kanawha Insurance Company	300127	Agent - Health	4/11/2008	7/20/2012
Inactive	Kanawha Insurance Company	300127	Agent - Life	4/11/2008	7/20/2012
Inactive	Lincoln National Reassurance Company	301919	Agent - Health	3/12/1998	1/6/2003
Inactive	Lincoln National Reassurance Company	301919	Agent - Life	3/12/1998	1/6/2003
Inactive	Metropolitan Life Insurance Company	301948	Agent - Health	3/5/2015	8/31/2018
Inactive	Metropolitan Life Insurance Company	301948	Agent - Life	3/5/2015	8/31/2018
Inactive	PacifiCare Life Assurance Company	301082	Agent - Health	6/17/1998	3/31/2005
Inactive	PacifiCare Life Assurance Company	301082	Agent - Life	6/17/1998	3/31/2005
Inactive	PacifiCare of Ohio Inc.	301904	Agent - Health	3/1/2001	3/31/2001
Inactive	PacifiCare of Ohio Inc.	301904	Agent - Health Maintenance Organization	11/5/1987	3/1/2001
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	7/17/2014	9/9/2015
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	7/17/2014	9/9/2015
Inactive	Swiss Re Life & Health America, Inc.	300722	Agent - Health	1/6/2003	12/22/2004
Inactive	Swiss Re Life & Health America, Inc.	300722	Agent - Life	1/6/2003	12/22/2004
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	7/17/2014	9/9/2015
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	7/17/2014	9/9/2015

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Assurex Agency Inc	722458	Agent - Health	4/8/2014	8/31/2018
Inactive	Assurex Agency Inc	722458	Agent - Life	4/8/2014	8/31/2018
Inactive	CBISA Reaquisitian Corp	547026	Agent - Health	3/25/2002	8/31/2018
Inactive	CBISA Reaquisitian Corp	547026	Agent - Life	3/25/2002	8/31/2018