Notification of Changes for Business Entity
General Information
Business Entity Name:	HUMANA MARKETPOINT
Incorporation / Formation Date:
FEIN:	611343508
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	KY
County:	JEFFERSON
Business Address
Address 1:	500 W MAIN STREET
Address 2:
City:	LOUISVILLE
State:	KY
Zip:	40202
Phone:	5024762445
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	500 W MAIN STREET
Address 2:
City:	LOUISVILLE
State:	KY
Zip:	40202
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	NO	New DBA/Trade Name:
Amend DBA/Trade Name:	NO	Old DBA/Trade Name:
Add/Delete Producers, Members, Owners, Partners, Officers and/or Directors:	YES

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
EARL COLEMAN	AGENT	994558		YES	08/11/2016
AARON COPE	AGENT	16728287		YES	08/11/2016
ORLANDO CRUZ	AGENT	9197543		YES	08/11/2016
JESSE DANIEL	AGENT	17024994		YES	08/11/2016
STEPHANIE DIAZ	AGENT	15114164		YES	08/11/2016
MARK DICKS	AGENT	8906258		YES	08/11/2016
MICHAEL DOW	AGENT	716922		YES	08/11/2016
ASHLEY DOWD	AGENT	10350043		YES	08/11/2016
GERARDO ESCOBAR	AGENT	1083645		YES	08/11/2016
NIESHA ESENE	AGENT	17668866		YES	08/11/2016
ANDREA FOWLER	AGENT	2880432		YES	08/11/2016
KATHYRN FOWLER	AGENT	9453006		YES	08/11/2016
KARNDEEP GILL	AGENT	17362878		YES	08/11/2016
KAY ANN GRAHAM	AGENT	15890162		YES	08/11/2016
ABBY OWENS	AGENT	17036678		YES	08/11/2016

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date

Title Business Entities Only
1. Is any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance? (i.e. banking, auto dealer, mortgage company)
2. Has any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance since the filing of the previous CN-65 or the original application?
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement

Submitted By
Submitted By:	STACY RAYBURN
Title:	COMPLIANCE ANALYST
Phone Number:	5024762445
Email Address:	SRAYBURN@HUMANA.COM