DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Blackburn, Douglas Dwayne	DOIID	350372	NAIC NPN	7191641

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Administrator	Not Applicable	6/28/1999	10/31/2018
Inactive	Resident	Agent	Health	4/21/1993	11/1/2018
Inactive	Resident	Agent	Health Maintenance Organization	7/1/1986	3/1/2001
Inactive	Resident	Agent	Life	4/21/1993	11/1/2018
Inactive	Resident	Life & Health Consultant	Not Applicable	2/7/1997	10/31/2018
* 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 Health Plans of Kentucky, Inc.	300999	Agent - Health	3/1/2001	5/17/2017
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health Maintenance Organization	7/1/1986	3/1/2001
Inactive	Anthem Life Insurance Company	301209	Agent - Health	4/21/1993	5/17/2017
Inactive	Anthem Life Insurance Company	301209	Agent - Life	4/21/1993	5/17/2017
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	4/9/2015	11/1/2018
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	4/9/2015	11/1/2018
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	4/9/2015	11/1/2018
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	4/9/2015	4/30/2018

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Acordia of Lexington Inc.	401285	Agent - Life	1/9/1995	12/10/2001
Inactive	Acordia of Lexington Inc.	401285	Agent - Health	1/9/1995	12/10/2001
Inactive	Administrative Services Group Inc.	401173	Agent - Life	11/6/1997	2/17/2009
Inactive	Administrative Services Group Inc.	401173	Agent - Health	11/6/1997	2/17/2009
Inactive	Administrative Services Group Inc.	401173	Administrator - Not Applicable	6/28/1999	2/17/2009
Inactive	Arison Insurance Services, Inc.	401001	Agent - Life	6/14/1993	2/28/2003
Inactive	Arison Insurance Services, Inc.	401001	Agent - Health	6/14/1993	2/28/2003
Inactive	Commonwealth Administrators, LLC	397899	Agent - Life	12/31/1999	5/14/2015
Inactive	Commonwealth Administrators, LLC	397899	Agent - Health	12/31/1999	5/14/2015
Inactive	Commonwealth Administrators, LLC	397899	Administrator - Not Applicable	9/2/1999	10/31/2018