DEPARTMENT OF INSURANCE

Affiliations

Name	Placencio, David Gomez	DOIID	726237	NAIC NPN	7463495

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Life	4/9/2010	1/31/2017
Inactive	Non Resident	Agent	Health	4/9/2010	1/31/2017
* 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	Aetna Health Inc. (PA)	660717	Agent - Health	6/4/2010	1/31/2017
Inactive	Aetna Life Insurance Company	301140	Agent - Health	6/4/2010	1/31/2017
Inactive	Aetna Life Insurance Company	301140	Agent - Life	6/4/2010	1/31/2017
Inactive	American Continental Insurance Company	643130	Agent - Health	4/4/2013	11/11/2014
Inactive	American Continental Insurance Company	643130	Agent - Life	4/4/2013	11/11/2014
Inactive	American Retirement Life Insurance Company	706303	Agent - Health	6/4/2013	12/18/2014
Inactive	American Retirement Life Insurance Company	706303	Agent - Life	6/4/2013	12/18/2014
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	7/10/2013	12/5/2014
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	4/4/2013	1/31/2017
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Life	4/4/2013	5/20/2016
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	7/10/2013	12/5/2014
Inactive	First Health Life & Health Insurance Company	301735	Agent - Health	4/25/2013	1/31/2017
Inactive	Gerber Life Insurance Company	300529	Agent - Health	11/12/2010	12/26/2012
Inactive	Gerber Life Insurance Company	300529	Agent - Life	11/12/2010	12/26/2012
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	3/15/2013	12/5/2014
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	3/15/2013	12/5/2014
Inactive	Humana Insurance Company	301104	Agent - Health	3/15/2013	2/4/2014
Inactive	Humana Insurance Company	301104	Agent - Life	3/15/2013	3/22/2013
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	3/15/2013	2/4/2014
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	3/15/2013	3/22/2013
Inactive	HumanaDental Insurance Company	301457	Agent - Health	11/16/2011	2/1/2012
Inactive	HumanaDental Insurance Company	301457	Agent - Life	11/16/2011	2/1/2012
Inactive	Kanawha Insurance Company	300127	Agent - Health	7/10/2013	9/27/2014
Inactive	Kanawha Insurance Company	300127	Agent - Life	7/10/2013	8/9/2013
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	5/21/2010	8/8/2011
Inactive	PacifiCare Life and Health Insurance Company	301304	Agent - Health	3/28/2011	8/2/2011
Inactive	SilverScript Insurance Company	663526	Agent - Health	2/4/2014	1/31/2017
Inactive	Standard Life and Accident Insurance Company	301534	Agent - Health	4/28/2011	10/25/2012
Inactive	Standard Life and Accident Insurance Company	301534	Agent - Life	4/28/2011	10/25/2012
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	5/21/2010	8/8/2011
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	5/21/2010	8/8/2011
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	4/15/2013	12/28/2016
Inactive	UnitedHealthcare Insurance Company of America	301552	Agent - Health	9/15/2016	12/28/2016
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	4/15/2013	12/5/2016
Inactive	UnitedHealthcare of Wisconsin, Inc.	871491	Agent - Health	9/12/2015	12/28/2016

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Humana MarketPOINT Inc.	398092	Agent - Life	9/19/2011	3/31/2016
Inactive	Humana MarketPOINT Inc.	398092	Agent - Health	9/19/2011	3/31/2016
Inactive	Longevity Alliance Inc	658429	Agent - Life	6/30/2015	12/16/2016
Inactive	Longevity Alliance Inc	658429	Agent - Health	6/30/2015	12/16/2016