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:	5024762445
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
MARK A KAZMIER	AGENT	16523711	YES		03/17/2016
SEAN KELLY	AGENT	17687000	YES		03/17/2016
YARON I KFIR	AGENT	3819716	YES		03/17/2016
MATTHEW M KOFRON	AGENT	6222385	YES		03/17/2016
MAX KOPEL	AGENT	8679837	YES		03/17/2016
HOLLY M KURT	AGENT	9453005	YES		03/17/2016
STEVEN D LIBER	AGENT	8502925	YES		03/17/2016
JOHN E LLOYD	AGENT	16448024	YES		03/17/2016
CHRISTINE LOPES	AGENT	7505344	YES		03/17/2016
ERIK N LUNA	AGENT	8468448	YES		03/17/2016
RICARDO A LUNA	AGENT	1513760	YES		03/17/2016
PAUL T LUSE	AGENT	3331534	YES		03/17/2016
DAVID P LUTZ	AGENT	15208047	YES		03/17/2016
BRANDON L MALIN	AGENT	16967883	YES		03/17/2016
CHANROUTIE MARAJH	AGENT	7659928	YES		03/17/2016

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