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
BURTON SCOTT INGRAM	AGENT	1722365		YES	08/15/2016
CELIA ESTELA GARZA	AGENT	7336975		YES	08/15/2016
CHAKA-KHAN D. CARTER	AGENT	7789328		YES	08/15/2016
CHRIS PAUL LYONS	AGENT	9113449		YES	08/15/2016
CHRISTOPHER J JONES	AGENT	8866553		YES	08/15/2016
COMFORT ESSIET	AGENT	15904474		YES	08/15/2016
DAPHNE MITCHELL	AGENT	10214868		YES	08/15/2016
DARYL ANTHONY MAPP	AGENT	16299790		YES	08/15/2016

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