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:	YES

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
BOLTON-GRESHAM, MS. RACENE	AGENT	2342033	YES		11/03/2017
BONCEK, MS. SHARON MARIE	AGENT	1255228	YES		11/03/2017
BOND, MS. DEADRA L	AGENT	18101322	YES		11/03/2017
BORMANN, MR. BRIAN RAY	AGENT	18523869	YES		11/03/2017
BOTRE, MR. AKHIL	AGENT	16655337	YES		11/03/2017
BOUDREAU, MR. DEREK	AGENT	18038504	YES		11/03/2017
BOWEN, MS. DIANE	AGENT	18229132	YES		11/03/2017
BOYER, MS. BERTHA	AGENT	7898448		YES	11/03/2017
BRADLEY, MR. RICHARD SCOTT	AGENT	3417598		YES	11/03/2017
BRADLEY, MR. ROGER J.	AGENT	8400614		YES	11/03/2017
BRAGA, MR. ADAM JOSEPH	AGENT	18492212	YES		11/03/2017
BRANKER, MS. JOI S. (GIEL)	AGENT	18504081	YES		11/03/2017
BREVIL, MS. ROOXANDRA C	AGENT	17019145		YES	11/03/2017
BREWSTER, MR. ERIC	AGENT	8004647		YES	11/03/2017
BRICKEY, MR. SCOTT D	AGENT	2090234		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