DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Heyduck, Charles Otto	DOIID	343532	NAIC NPN	7188574

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Health Maintenance Organization	4/28/1989	3/1/2001
Inactive	Resident	Agent	Life	12/17/1993	1/31/2011
Inactive	Resident	Agent	Health	12/17/1993	1/31/2011
AFFIDAVIT ON FILE
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Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	3/1/2001	4/1/2002
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health Maintenance Organization	4/28/1989	3/1/2001
Inactive	Anthem Life Insurance Company	301209	Agent - Health	3/2/2000	1/31/2011
Inactive	Anthem Life Insurance Company	301209	Agent - Life	3/2/2000	1/31/2011

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	12/17/1993	6/23/2008
Inactive	Arison Insurance Services, Inc.	401001	Agent - Health	12/17/1993	6/23/2008