DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Jeffrey A	DOIID	993623	NAIC NPN	3700047

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	5/9/2018		9/30/2024
Active	Non Resident	Agent	Life	5/9/2018		9/30/2024
* 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

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Accendo Insurance Company	300312	Agent - Health	9/10/2021	11/17/2023
Active	Accendo Insurance Company	300312	Agent - Life	6/10/2020
Active	Aetna Health Inc. (PA)	660717	Agent - Health	10/24/2018
Active	Aetna Health and Life Insurance Company	300523	Agent - Health	7/1/2020
Active	Aetna Health of Ohio Inc.	1065035	Agent - Health	8/6/2020
Active	Aetna Life Insurance Company	301140	Agent - Health	10/24/2018
Active	Aetna Life Insurance Company	301140	Agent - Life	10/24/2018
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	4/7/2021	4/26/2021
Inactive	American Continental Insurance Company	643130	Agent - Life	7/1/2020	8/11/2021
Active	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	8/10/2018
Active	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Life	3/15/2021
Active	First Health Life & Health Insurance Company	301735	Agent - Health	10/24/2018
Inactive	Guarantee Trust Life Insurance Company	301043	Agent - Health	5/23/2018	12/30/2020
Inactive	Guarantee Trust Life Insurance Company	301043	Agent - Life	5/23/2018	12/30/2020
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	2/25/2020	1/22/2021
Active	SilverScript Insurance Company	663526	Agent - Health	8/23/2019
Inactive	United World Life Insurance Company	300532	Agent - Health	2/25/2020	1/22/2021
Inactive	WellCare Health Insurance Company of Kentucky, Inc.	301478	Agent - Health	3/10/2020	12/28/2021
Active	WellCare Prescription Insurance Inc.	654329	Agent - Health	3/10/2020

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	GoldenCare USA, LLC	398142	Agent - Life	5/30/2018
Active	GoldenCare USA, LLC	398142	Agent - Health	5/30/2018
Active	National Independent Brokers, LLC	502029	Agent - Life	5/30/2018
Active	National Independent Brokers, LLC	502029	Agent - Health	5/30/2018