DEPARTMENT OF INSURANCE

Affiliations

Name	Black, Kerry Clayton	DOIID	707005	NAIC NPN	9358240

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Health	10/21/2009	9/30/2012
Inactive	Non Resident	Agent	Property	6/4/2009	9/30/2012
Inactive	Non Resident	Agent	Life	10/21/2009	9/30/2012
Inactive	Non Resident	Agent	Casualty	6/4/2009	9/30/2012
* 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	Aetna Health Inc. (PA)	660717	Agent - Health	11/30/2009	9/30/2012
Inactive	Aetna Life Insurance Company	301140	Agent - Health	11/30/2009	9/30/2012
Inactive	Aetna Life Insurance Company	301140	Agent - Life	11/30/2009	9/30/2012
Inactive	Anthem Life Insurance Company	301209	Agent - Health	10/8/2010	11/1/2011
Inactive	Anthem Life Insurance Company	301209	Agent - Life	10/8/2010	11/1/2011
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	6/15/2010	2/9/2012
Inactive	Connecticut General Life Insurance Company	301333	Agent - Health	10/30/2009	9/30/2012
Inactive	Connecticut General Life Insurance Company	301333	Agent - Life	9/28/2010	9/30/2012
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	8/25/2011	2/9/2012
Inactive	First Health Life & Health Insurance Company	301735	Agent - Health	11/15/2010	9/30/2012
Inactive	Great American Assurance Company	300327	Agent - Casualty	6/24/2009	9/30/2012
Inactive	Great American Assurance Company	300327	Agent - Property	6/24/2009	9/30/2012
Inactive	Great West Casualty Company	301015	Agent - Casualty	11/29/2011	3/22/2012
Inactive	Great West Casualty Company	301015	Agent - Property	11/29/2011	3/22/2012
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	12/2/2009	2/9/2012
Inactive	Humana Insurance Company	301104	Agent - Health	11/2/2009	2/9/2012
Inactive	Humana Insurance Company	301104	Agent - Life	11/2/2009	2/9/2012
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	6/15/2010	2/9/2012
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	6/15/2010	2/9/2012
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	2/28/2011	11/13/2011
Inactive	PacifiCare Life and Health Insurance Company	301304	Agent - Health	9/15/2010	1/31/2011
Inactive	Sterling Life Insurance Company	301947	Agent - Health	10/21/2009	8/12/2010
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	9/15/2010	1/31/2011
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	9/15/2010	1/31/2011
Inactive	WellCare Prescription Insurance Inc.	654329	Agent - Health	11/20/2010	1/23/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Designated Agent Company Inc.	681257	Agent - Health	10/8/2010	11/23/2011
Inactive	Designated Agent Company Inc.	681257	Agent - Life	10/8/2010	11/23/2011
Inactive	Extend Insurance Services, LLC	625753	Agent - Health	11/2/2009	9/30/2012
Inactive	Extend Insurance Services, LLC	625753	Agent - Life	11/2/2009	9/30/2012
Inactive	Heritage Insurance USA	704116	Agent - Property	9/16/2009	9/30/2012
Inactive	Heritage Insurance USA	704116	Agent - Casualty	9/16/2009	9/30/2012