DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Clements Iii, Lacey	DOIID	973561	NAIC NPN	18570451

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	10/19/2017	11/30/2021
Inactive	Non Resident	Agent	Health	10/19/2017	11/30/2021
* 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	3/9/2018	7/8/2021
Inactive	Aetna Life Insurance Company	301140	Agent - Health	3/9/2018	7/8/2021
Inactive	Aetna Life Insurance Company	301140	Agent - Life	3/9/2018	7/8/2021
Inactive	Anthem Life Insurance Company	301209	Agent - Health	12/1/2017	5/8/2021
Inactive	Anthem Life Insurance Company	301209	Agent - Life	12/1/2017	5/8/2021
Inactive	CIGNA Health & Life Insurance Company	301783	Agent - Health	12/27/2017	11/30/2021
Inactive	Coventry Health and Life Insurance Company	301771	Agent - Health	3/2/2018	11/30/2021
Inactive	First Health Life & Health Insurance Company	301735	Agent - Health	3/9/2018	7/8/2021
Inactive	Loyal American Life Insurance Company	301172	Agent - Health	5/25/2018	12/22/2020
Inactive	SilverScript Insurance Company	663526	Agent - Health	10/24/2019	7/8/2021
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	1/7/2018	1/20/2021
Inactive	UnitedHealthcare Insurance Company of America	301552	Agent - Health	1/7/2018	12/21/2018
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	8/6/2019	1/20/2021
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	7/15/2018	1/20/2021
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	1/7/2018	1/20/2021

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	12/1/2017	5/10/2021
Inactive	Designated Agent Company Inc.	681257	Agent - Life	12/1/2017	5/10/2021
Inactive	Mercer Health & Benefits Administration Llc	656414	Agent - Health	1/28/2019	11/30/2021
Inactive	Mercer Health & Benefits Administration Llc	656414	Agent - Life	1/28/2019	7/8/2021