Notification of Changes for Business Entity
General Information
Business Entity Name:	HUMANA MARKETPOINT AGENCY
Incorporation / Formation Date:
FEIN:	611343508
Ohio License Number:	24204
NPN:
DBA / Trade Name:
State of Domicile:	KY
County:	JEFFERSON
Business Address
Address 1:	500 W MAIN ST.
Address 2:
City:	LOUISVILLE
State:	KY
Zip:	40202
Phone:	502-476-3149
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	500 W MAIN ST.
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
GHERRI DAVIS	AGENT	17342943		YES	03/22/2016
JOSEPH THOMAS MCCOLLOCH	AGENT	7689582		YES	03/22/2016
TINICIA CREAGER	AGENT	14863242		YES	03/22/2016
JEFFREY L MCDONALD	AGENT	15938682		YES	03/22/2016
SHELDON J BRYANT	AGENT	15890265		YES	03/22/2016
DEBORAH A RUSHER	AGENT	8899041		YES	03/22/2016
LASHANDRA VANICE LANKFORD	AGENT	16401859		YES	03/22/2016
GARY SAMUEL CROSSFIELD	AGENT	559019		YES	03/22/2016
LORENZO MANUEL MANZANO	AGENT	8626062		YES	03/22/2016
JERRY ARCHIE DEAN PEARSON	AGENT	15739683		YES	03/22/2016
CHERYL ANN FURST	AGENT	1911377		YES	03/22/2016
LARRY GENE GOING	AGENT	17085349		YES	03/22/2016
MARK ANTHONY CEDILLO	AGENT	2041898		YES	03/22/2016
DAVID GUERRERO	AGENT	17095514		YES	03/22/2016
JOSEPH DAVID RAMON	AGENT	16746202		YES	03/22/2016

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)	NO
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?	NO
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:	RHONDA WINFORD
Title:	CONTRACTING ANALYST
Phone Number:	502-476-3149
Email Address:	RWINFORD@HUMANA.COM