DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Kelly William	DOIID	789802	NAIC NPN	8195318

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	9/8/2020		1/31/2026
Inactive	Non Resident	Agent	Life	1/4/2019	1/31/2020
* 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	11/15/2025	01/31/2026

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Accendo Insurance Company	300312	Agent - Health	11/22/2022	11/17/2023
Active	Aetna Health Inc. (PA)	660717	Agent - Health	9/16/2020
Active	Aetna Health and Life Insurance Company	300523	Agent - Health	11/22/2022
Active	Aetna Health of Ohio Inc.	1065035	Agent - Health	9/16/2020
Active	Aetna Life Insurance Company	301140	Agent - Health	9/16/2020
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	9/23/2019	1/31/2020
Inactive	Anthem Health Plans of New Hampshire, Inc.	944064	Agent - Health	9/26/2021	3/5/2022
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Health	9/26/2021	3/5/2022
Inactive	Anthem Life Insurance Company	301209	Agent - Health	9/23/2019	1/31/2020
Inactive	Anthem Life Insurance Company	301209	Agent - Life	9/23/2019	1/31/2020
Active	Arcadian Health Plan, Inc.	728196	Agent - Health	1/16/2024
Inactive	Chesapeake Life Insurance Company (The)	301017	Agent - Health	10/29/2019	1/31/2020
Inactive	Chesapeake Life Insurance Company (The)	301017	Agent - Life	10/29/2019	1/31/2020
Inactive	Compcare Health Services Insurance Corporation	948751	Agent - Health	9/26/2021	3/5/2022
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	2/2/2019	1/31/2020
Active	Humana Benefit Plan of Illinois, Inc.	781543	Agent - Health	2/24/2023
Active	Humana Insurance Company	301104	Agent - Health	1/21/2025
Inactive	Humana Insurance Company	301104	Agent - Life	2/15/2019	11/26/2019
Inactive	Humana Medical Plan, Inc.	801568	Agent - Health	11/21/2022	12/12/2024
Inactive	Lumico Life Insurance Company	300354	Agent - Health	12/4/2019	1/31/2020
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	10/31/2020	11/22/2022
Inactive	Omaha Insurance Company	751908	Agent - Health	9/13/2012	1/31/2018
Active	SilverScript Insurance Company	663526	Agent - Health	1/11/2022
Inactive	United World Life Insurance Company	300532	Agent - Health	10/31/2020	11/22/2022
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	10/31/2020	11/22/2022
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	9/13/2012	7/22/2013
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	9/10/2020	7/25/2022
Inactive	UnitedHealthcare Insurance Company of the River Valley	1027817	Agent - Health	9/10/2020	7/25/2022
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	9/10/2020	12/23/2021
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	9/10/2020	7/25/2022
Inactive	WellCare Health Insurance Company of Kentucky, Inc.	301478	Agent - Health	10/11/2020	8/29/2022
Inactive	WellCare Prescription Insurance Inc.	654329	Agent - Health	10/10/2020	12/29/2021

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Health Plan Intermediaries Holdings	786463	Agent - Health	12/17/2019	1/31/2020
Denied	TZ Insurance Solutions LLC	727470	Agent - Life
Active	TZ Insurance Solutions LLC	727470	Agent - Health	1/22/2025
Inactive	Trubridge Inc	717747	Agent - Health	8/14/2023	1/22/2025