DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Lisa M	DOIID	381607	NAIC NPN	1487828

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Health	12/29/2008		9/30/2026
Active	Resident	Agent	Life	12/29/2008		9/30/2026
Inactive	Resident	Agent	Health Maintenance Organization	4/29/1994	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	07/15/2024	09/30/2024	07/17/2024	07/17/2024	Yes

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	3/10/1995	3/23/2004
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	3/10/1995	3/23/2004
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	9/17/2013	3/14/2019
Active	CompBenefits Insurance Company	301864	Agent - Health	10/25/2019
Inactive	Continental General Insurance Company	300691	Agent - Health	8/9/2018	1/25/2019
Inactive	Continental General Insurance Company	300691	Agent - Life	8/9/2018	1/25/2019
Active	Dental Concern Inc. (The)	301641	Agent - Health	10/31/2013
Active	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	12/15/2014
Active	Humana Health Plan of Ohio Inc.	301565	Agent - Health	10/4/2018
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health Maintenance Organization	4/29/1994	3/1/2001
Active	Humana Health Plan, Inc.	300142	Agent - Health	1/13/2009
Inactive	Humana Health Plan, Inc.	300142	Agent - Health Maintenance Organization	12/30/1997	3/1/2001
Active	Humana Insurance Company	301104	Agent - Health	1/13/2009
Active	Humana Insurance Company	301104	Agent - Life	1/13/2009
Active	Humana Insurance Company of Kentucky	300826	Agent - Health	10/31/2013
Active	Humana Medical Plan, Inc.	801568	Agent - Health	12/15/2014
Active	Humana Wisconsin Health Organization Insurance Corporation	830687	Agent - Health	12/21/2016
Inactive	Kanawha Insurance Company	300127	Agent - Health	1/13/2009	8/9/2018
Inactive	Kanawha Insurance Company	300127	Agent - Life	1/13/2009	8/9/2018
Inactive	Union Security Insurance Company	301844	Agent - Health	11/9/1993	3/31/1997
Inactive	Union Security Insurance Company	301844	Agent - Life	11/9/1993	3/31/1997

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 - Life	2/1/2008	9/30/2008
Inactive	Humana MarketPOINT Inc.	398092	Agent - Health	2/1/2008	9/30/2008