DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

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	Life	5/9/2018		9/30/2026
Active	Non Resident	Agent	Health	5/9/2018		9/30/2026
* 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	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