DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Given, Charles Clark	DOIID	753786	NAIC NPN	16219104

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Life	5/25/2011	1/1/2013
Inactive	Resident	Agent	Health	5/25/2011	1/1/2013
* 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	Anthem Life Insurance Company	301209	Agent - Health	8/1/2011	1/1/2013
Inactive	Anthem Life Insurance Company	301209	Agent - Life	8/1/2011	1/1/2013
Inactive	Colonial Life and Accident Insurance Company	300846	Agent - Health	7/5/2011	1/1/2013
Inactive	Colonial Life and Accident Insurance Company	300846	Agent - Life	7/5/2011	1/1/2013
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	9/1/2011	1/1/2013
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	9/1/2011	1/1/2013
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	9/1/2011	1/1/2013
Inactive	Humana Insurance Company	301104	Agent - Health	8/24/2011	1/1/2013
Inactive	Humana Insurance Company	301104	Agent - Life	8/24/2011	1/1/2013
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	9/1/2011	1/1/2013
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	9/1/2011	1/1/2013
Inactive	State Life Insurance Company	301497	Agent - Health	8/18/2011	1/1/2013
Inactive	State Life Insurance Company	301497	Agent - Life	8/18/2011	1/1/2013

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	8/12/2011	1/1/2013
Inactive	Designated Agent Company Inc.	681257	Agent - Life	8/12/2011	1/1/2013