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:	502-476-3149
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
TRINH VI LY	AGENT	17030691		YES	03/18/2016
CHRISTOPHER KYLE SIMS	AGENT	17029345		YES	03/18/2016
TERESA SHAWN GREATOREX	AGENT	1270841		YES	03/18/2016
LISA ANN HARPER	AGENT	3067438		YES	03/18/2016
REGINA E WEST	AGENT	2807877		YES	03/18/2016
JOSEPH B MARTIN	AGENT	1721721		YES	03/18/2016
LEROY R DEHART	AGENT	7456081		YES	03/18/2016
JOSEPH MICHAEL STINNETT	AGENT	3974265		YES	03/18/2016
CARL E FINCH	AGENT	15942214		YES	03/18/2016
ARTURO FERNANDEZ	AGENT	444771		YES	03/18/2016
LASHAWN SEMETRIUS HILLS	AGENT	16352650		YES	03/18/2016
SIAMEL MARY CAPAZ	AGENT	7906158		YES	03/18/2016
MICHAEL JEFFREY ROBIN	AGENT	450426		YES	03/18/2016
DANA D MEEKS	AGENT	9746990		YES	03/18/2016
DANIELLA A COOPER	AGENT	7922100		YES	03/18/2016

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)	NO
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?	NO
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:	RHONDA WINFORD
Title:	CONTRACTING ANALYST
Phone Number:	502-476-3149
Email Address:	RWINFORD@HUMANA.COM