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
JASMINE BURTON	AGENT	8901593	YES		08/16/2016
RANDY TILBERT	AGENT	7029131	YES		08/16/2016
JAMES FRAYLICK	AGENT	6702170	YES		08/16/2016
EVE LOSEK	AGENT	17682223	YES		08/16/2016
CHAD TELLEFSEN	AGENT	17659237	YES		08/16/2016
JESUS VALENCIANA	AGENT	17092870	YES		08/16/2016
CARI STONE	AGENT	16689597	YES		08/16/2016
SAMANTHA HEIMSTREET	AGENT	17658368	YES		08/16/2016
MALIKAH SALEEM	AGENT	17659262	YES		08/16/2016
WANDA KRANTZ	AGENT	17718338	YES		08/16/2016
DAVID JAMES	AGENT	7090872	YES		08/16/2016
HECTOR MERCEDES	AGENT	16708761	YES		08/16/2016
MALACHI MASON	AGENT	8843949	YES		08/16/2016
ARMANDO RODRIGUEZ	AGENT	16837373	YES		08/16/2016
TIMOTHY MASON	AGENT	6941491	YES		08/16/2016

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