DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Carlson, Jerald David	DOIID	806273	NAIC NPN	621510

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	3/21/2013	9/30/2023
Inactive	Non Resident	Agent	Life	3/21/2013	9/30/2023
* 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	Berkshire Life Insurance Company of America	300983	Agent - Health	6/22/2016	10/12/2020
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Life	6/22/2016	10/12/2020
Inactive	Golden Rule Insurance Company	301943	Agent - Health	7/7/2015	2/14/2019
Inactive	Golden Rule Insurance Company	301943	Agent - Life	7/7/2015	2/14/2019
Inactive	Guardian Life Insurance Company of America	301316	Agent - Health	6/22/2016	10/5/2021
Inactive	Guardian Life Insurance Company of America	301316	Agent - Life	6/22/2016	10/5/2021
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	8/31/2017	9/30/2023
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	8/31/2017	9/30/2023
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	8/31/2017	9/30/2023
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	8/31/2017	9/30/2023
Inactive	UnitedHealthcare Life Insurance Company	301517	Agent - Health	7/7/2015	11/4/2016
Inactive	UnitedHealthcare Life Insurance Company	301517	Agent - Life	7/7/2015	11/4/2016

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Wallace Welch & Willingham Inc	684056	Agent - Health	5/20/2013	9/30/2023
Inactive	Wallace Welch & Willingham Inc	684056	Agent - Life	5/20/2013	9/30/2023