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
KATELYN HARDY	AGENT	17320878		YES	08/15/2016
KATRINA TREVINO	AGENT	16705999		YES	08/15/2016
KEVIN SCHMIDT	AGENT	17346368		YES	08/15/2016
KHAMEIAH WILLIAMSON	AGENT	17305738		YES	08/15/2016
LEIGZYS ORTEGA	AGENT	8939942		YES	08/15/2016
LEOPOLD JAMES	AGENT	8794917		YES	08/15/2016
LORI HERRILKO	AGENT	2780916		YES	08/15/2016
MARGARITA HERNANDEZ	AGENT	16567009		YES	08/15/2016
MARTIZA ISER	AGENT	17359050		YES	08/15/2016
MARK SUMMERS	AGENT	1725401		YES	08/15/2016
MARK WILLEKE	AGENT	1766992		YES	08/15/2016
MATTHEW TRAHAN	AGENT	17663954		YES	08/15/2016
MELINDA STUEBER	AGENT	8052680		YES	08/15/2016
MICHAEL O REILLY	AGENT	7013910		YES	08/15/2016
MIGUEL RAMOS	AGENT	17701312		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