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 WEST MAIN STREET
Address 2:
City:	LOUISVILLE
State:	KY
Zip:	40202
Phone:	502-580-1000
Fax:
Business Web Site Address:
Business Email Address:	JBRADY8@HUMANA.COM
Mailing Address
Address 1:	500 WEST 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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
ALI, MR. GUY	AGENT	17471689	YES		11/03/2017
ALLEN, MS. JANET PATRICIA	AGENT	3692770	YES		11/03/2017
ALMUWMINU, MS. LAYLAA A.	AGENT	18496433	YES		11/03/2017
ALONSO, MS. AKEMI	AGENT	8770481		YES	11/03/2017
ALSTON, MS. BEVERLY	AGENT	17050973	YES		11/03/2017
ALVARADO, MR. JOSEPH PAUL	AGENT	18062039	YES		11/03/2017
ALVAREZ, MS. GRETCHEN	AGENT	17000818		YES	11/03/2017
AMADON, MS. TASHA M	AGENT	18100549	YES		11/03/2017
AMOLE, MR. JED ROBERT	AGENT	18486371	YES		11/03/2017
AMRINE, MR. DUSTIN BRYAN	AGENT	18481674	YES		11/03/2017
ANAYA, MS. VERONICA	AGENT	8942376		YES	11/03/2017
ANDERSON, MS. MARSHA N	AGENT	18088820	YES		11/03/2017
ANDRADE, MR. EDWARD J.	AGENT	599649		YES	11/03/2017
ANDRADE, MR. JORGE	AGENT	17126984	YES		11/03/2017
ANTHONY, MS. ANDREA	AGENT	18502606	YES		11/03/2017

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:	JENNIFER BRADY
Title:	PROJECT MANAGER
Phone Number:	502-471-9094
Email Address:	JBRADY8@HUMANA.COM