DEPARTMENT OF INSURANCE

Affiliations

Name	Ballard, Keith Edward	DOIID	321134	NAIC NPN	7168299

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Life	2/11/1999	12/1/2000
Inactive	Resident	Agent	Health Maintenance Organization	5/24/1999	12/1/2000
Inactive	Resident	Agent	Health	2/11/1999	12/1/2000
* 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	Anthem Life Insurance Company	301209	Agent - Health	7/20/1999	12/1/2000
Inactive	Anthem Life Insurance Company	301209	Agent - Life	7/20/1999	12/1/2000
Inactive	Baptist Health Plan, Inc.	300157	Agent - Health Maintenance Organization	5/24/1999	12/1/2000
Inactive	Equitable Financial Life Insurance Company of America	301772	Agent - Life	2/11/1999	10/1/1999
Inactive	Humana Health Plan, Inc.	300142	Agent - Health Maintenance Organization	7/23/1999	11/1/2000
Inactive	Humana Insurance Company	301104	Agent - Health	7/23/1999	11/1/2000
Inactive	Humana Insurance Company	301104	Agent - Life	7/23/1999	11/1/2000
Inactive	Illinois Mutual Life Insurance Company	301479	Agent - Health	6/21/1999	12/1/2000
Inactive	Illinois Mutual Life Insurance Company	301479	Agent - Life	6/21/1999	12/1/2000
Inactive	MONY Life Insurance Company	301141	Agent - Health	2/11/1999	10/1/1999
Inactive	MONY Life Insurance Company	301141	Agent - Life	2/11/1999	10/1/1999
Inactive	Medical Life Insurance Company	300693	Agent - Health	8/31/1999	12/31/2004
Inactive	Medical Life Insurance Company	300693	Agent - Life	8/31/1999	12/31/2004
Inactive	Paul Revere Life Insurance Company	300971	Agent - Health	3/11/1999	8/24/2000
Inactive	Paul Revere Life Insurance Company	300971	Agent - Life	3/11/1999	8/24/2000
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	3/11/1999	8/24/2000
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	3/11/1999	8/24/2000
Inactive	Union Central Life Insurance Company	300307	Agent - Health	7/14/1999	8/17/2000
Inactive	Union Central Life Insurance Company	300307	Agent - Life	7/14/1999	8/17/2000
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health Maintenance Organization	9/22/1999	12/1/2000

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Arison Insurance Services, Inc.	401001	Agent - Life	6/25/1999	12/1/2000
Inactive	Arison Insurance Services, Inc.	401001	Agent - Health	6/25/1999	12/1/2000