DEPARTMENT OF INSURANCE

Affiliations

Name	Carbillano, Mark A	DOIID	598658	NAIC NPN	8083997

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Life	6/11/2024	6/30/2027
Active	Non Resident	Agent	Health	6/11/2024	6/30/2027
* 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	04/15/2025	06/30/2025	04/03/2025	04/03/2025	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Aetna Health Inc. (PA)	660717	Agent - Health	8/10/2010	6/30/2015
Inactive	Aetna Life Insurance Company	301140	Agent - Health	8/10/2010	6/30/2015
Inactive	Aetna Life Insurance Company	301140	Agent - Life	8/10/2010	6/30/2015
Inactive	Chase Insurance Life and Annuity Company	300518	Agent - Life	1/3/2005	4/1/2007
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	12/28/2010	3/22/2013
Inactive	Companion Life Insurance Company	300191	Agent - Health	12/7/2004	2/19/2007
Inactive	Companion Life Insurance Company	300191	Agent - Life	12/7/2004	2/19/2007
Inactive	Continental General Insurance Company	300691	Agent - Health	12/6/2004	11/11/2005
Inactive	Continental General Insurance Company	300691	Agent - Life	12/6/2004	11/11/2005
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	12/28/2010	3/22/2013
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	7/2/2013	6/30/2015
Inactive	Humana Insurance Company	301104	Agent - Health	12/28/2010	3/22/2013
Inactive	Humana Insurance Company	301104	Agent - Life	12/28/2010	3/22/2013
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	7/2/2013	6/30/2015
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	7/2/2013	6/30/2015
Inactive	Jefferson National Life Insurance Company	300258	Agent - Life	12/1/2004	6/8/2006
Inactive	Kanawha Insurance Company	300127	Agent - Health	12/28/2010	3/22/2013
Inactive	Kanawha Insurance Company	300127	Agent - Life	12/28/2010	3/22/2013
Inactive	Protective Life Insurance Company	300638	Agent - Life	4/1/2007	12/30/2009
Inactive	Time Insurance Company	300683	Agent - Health	7/19/2007	3/18/2009
Inactive	Time Insurance Company	300683	Agent - Life	7/19/2007	3/18/2009
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	6/14/2006	4/6/2010
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	6/14/2006	11/9/2012
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	6/14/2006	11/9/2012
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	6/14/2006	4/6/2010
Inactive	WellCare Health Plans of Kentucky, Inc.	838592	Agent - Health	9/25/2024	11/7/2024

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Alera Group, Inc.	941451	Agent - Life
Inactive	Alera Group, Inc.	941451	Agent - Health	10/31/2024	11/7/2024