DEPARTMENT OF INSURANCE

Affiliations

Name	Clemons, Dale Eugene	DOIID	380447	NAIC NPN	2766482

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Health Maintenance Organization	12/30/1998	3/1/2001
Inactive	Resident	Agent	Variable Life and Variable Annuities	6/1/2001	5/31/2008
Inactive	Resident	Agent	Life	8/14/2008	6/1/2010
Inactive	Resident	Agent	Property	3/9/2010	6/1/2010
Inactive	Resident	Agent	Health	8/14/2008	6/1/2010
Inactive	Resident	Agent	General Lines	11/26/1997	8/15/2000
Inactive	Resident	Agent	Casualty	3/9/2010	6/1/2010
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Notice: The Department verifies, at the time of application for a Variable Life and Variable Annuity line of authority, that an agent is registered with the Financial Industry Regulatory Authority (FINRA) and the applicant has passed the Series 6 or greater exam. The Department does not verify registration with FINRA after the agent is qualified by the Department to receive the Variable Life and Variable Annuity line of authority. If you have questions about a broker’s FINRA registration status, you should check this status directly with FINRA.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Aetna Health Inc.	300694	Agent - Health	9/15/2000	12/31/2007
Inactive	Aetna Health Inc. (PA)	660717	Agent - Health	12/31/2007	5/31/2008
Inactive	Aetna Life Insurance Company	301140	Agent - Health	9/15/2000	5/31/2008
Inactive	Aetna Life Insurance Company	301140	Agent - Life	9/15/2000	5/31/2008
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Health	11/17/2001	10/8/2004
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	11/17/2001	10/8/2004
Inactive	Allied Life Insurance Company	301294	Agent - Health	10/28/1997	4/27/1998
Inactive	Allied Life Insurance Company	301294	Agent - Life	10/28/1997	4/27/1998
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	2/25/2002	5/31/2008
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	2/25/2002	5/31/2008
Inactive	American General Life Insurance Company	301585	Agent - Health	5/19/2004	5/31/2008
Inactive	American General Life Insurance Company	301585	Agent - Life	5/19/2004	5/31/2008
Inactive	American National General Insurance Company	301944	Agent - Casualty	8/15/2000	1/4/2002
Inactive	American National General Insurance Company	301944	Agent - General Lines	11/26/1997	8/15/2000
Inactive	American National General Insurance Company	301944	Agent - Property	8/15/2000	1/4/2002
Inactive	American National Insurance Company	301861	Agent - Health	12/9/1997	1/4/2002
Inactive	American National Insurance Company	301861	Agent - Life	12/9/1997	1/4/2002
Inactive	American National Insurance Company	301861	Agent - Variable Life and Variable Annuities	6/1/2001	5/31/2008
Inactive	American National Life Insurance Company of Texas	300912	Agent - Health	5/8/1998	1/4/2002
Inactive	American National Life Insurance Company of Texas	300912	Agent - Life	5/8/1998	1/4/2002
Inactive	American National Property and Casualty Company	300392	Agent - Casualty	8/15/2000	1/4/2002
Inactive	American National Property and Casualty Company	300392	Agent - General Lines	11/26/1997	8/15/2000
Inactive	American National Property and Casualty Company	300392	Agent - Property	8/15/2000	1/4/2002
Inactive	Athene Annuity and Life Company	301893	Agent - Life	3/11/2002	12/29/2004
Inactive	Clarendon National Insurance Company	300843	Agent - Health	11/14/2002	10/21/2005
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	11/6/2008	6/1/2010
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	8/15/2000	9/3/2002
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - General Lines	10/21/1998	8/15/2000
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	8/15/2000	9/3/2002
Inactive	Foremost Signature Insurance Company	300140	Agent - Casualty	8/15/2000	9/3/2002
Inactive	Foremost Signature Insurance Company	300140	Agent - General Lines	10/21/1998	8/15/2000
Inactive	Foremost Signature Insurance Company	300140	Agent - Property	8/15/2000	9/3/2002
Inactive	Golden Rule Insurance Company	301943	Agent - Health	2/12/2009	6/1/2010
Inactive	Golden Rule Insurance Company	301943	Agent - Life	2/12/2009	6/1/2010
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	11/6/2008	6/1/2010
Inactive	Humana Health Plan, Inc.	300142	Agent - Health Maintenance Organization	12/30/1998	3/1/2001
Inactive	Humana Insurance Company	301104	Agent - Health	11/6/2008	6/1/2010
Inactive	Humana Insurance Company	301104	Agent - Life	11/6/2008	6/1/2010
Inactive	HumanaDental Insurance Company	301457	Agent - Health	11/6/2008	6/1/2010
Inactive	HumanaDental Insurance Company	301457	Agent - Life	11/6/2008	6/1/2010
Inactive	Illinois Mutual Life Insurance Company	301479	Agent - Health	5/27/1999	12/16/2002
Inactive	Illinois Mutual Life Insurance Company	301479	Agent - Life	5/27/1999	12/16/2002
Inactive	Kanawha Insurance Company	300127	Agent - Health	11/6/2008	6/1/2010
Inactive	Kanawha Insurance Company	300127	Agent - Life	11/6/2008	6/1/2010
Inactive	Medico Insurance Company	301559	Agent - Health	8/21/2008	7/16/2010
Inactive	Medico Insurance Company	301559	Agent - Life	8/21/2008	7/16/2010
Inactive	National States Insurance Company	300579	Agent - Health	4/8/1996	12/31/1997
Inactive	National States Insurance Company	300579	Agent - Life	4/8/1996	12/31/1997
Inactive	Paul Revere Life Insurance Company	300971	Agent - Health	8/11/1998	8/24/2000
Inactive	Paul Revere Life Insurance Company	300971	Agent - Life	8/11/1998	8/24/2000
Inactive	Physicians Life Insurance Company	300924	Agent - Health	3/11/2004	11/9/2004
Inactive	Physicians Life Insurance Company	300924	Agent - Life	3/7/2002	11/9/2004
Inactive	Physicians Mutual Insurance Company	301084	Agent - Health	10/9/2001	11/9/2004
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	9/16/1998	8/24/2000
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	9/16/1998	12/12/2005
Inactive	Standard Life and Accident Insurance Company	301534	Agent - Health	7/24/1998	1/22/2002
Inactive	Standard Life and Accident Insurance Company	301534	Agent - Life	7/24/1998	1/22/2002
Inactive	Talcott Resolution Life and Annuity Insurance Company	300932	Agent - Health	6/12/1996	10/15/2007
Inactive	Talcott Resolution Life and Annuity Insurance Company	300932	Agent - Life	6/12/1996	10/15/2007
Inactive	Time Insurance Company	300683	Agent - Health	2/5/2001	12/19/2006
Inactive	Time Insurance Company	300683	Agent - Life	2/5/2001	12/19/2006
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	12/9/2005	5/31/2008
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	12/9/2005	5/31/2008
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	12/9/2005	5/31/2008
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	12/9/2005	5/31/2008
Inactive	Western National Life Insurance Company	300461	Agent - Life	5/3/2004	11/21/2007

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Advanced Health Group, LLC	523817	Agent - Life	11/30/2001	1/13/2004
Inactive	Advanced Health Group, LLC	523817	Agent - Health	11/30/2001	1/13/2004
Inactive	Dental Choice Agency Inc.	398085	Agent - Health	3/17/2004	5/31/2008
Inactive	Diversified Health Services of KY Inc.	400660	Agent - Life	12/29/1997	3/6/2003
Inactive	Diversified Health Services of KY Inc.	400660	Agent - Health	12/29/1997	3/6/2003
Inactive	HealthSource LLC	548251	Agent - Life	4/15/2002	5/31/2008
Inactive	HealthSource LLC	548251	Agent - Health	4/15/2002	5/31/2008
Inactive	Medlink Inc	400721	Agent - Life	10/14/2002	5/31/2008
Inactive	Medlink Inc	400721	Agent - Health	10/14/2002	5/31/2008