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
DAVID GRANT	AGENT	1717684	YES		08/16/2016
BARBARA PRIEVE	AGENT	13775108	YES		08/16/2016
DAVID HARRISON	AGENT	16219455	YES		08/16/2016
BENJAMIN SEITZ	AGENT	16366487	YES		08/16/2016
ANNE STRIETER	AGENT	17649267	YES		08/16/2016
JOSE SANCHEZ	AGENT	17096920	YES		08/16/2016
DANA SANCHEZ	AGENT	17653949	YES		08/16/2016
SETH ROBINSON	AGENT	17342851	YES		08/16/2016
JOHN JUNGEN	AGENT	17675167	YES		08/16/2016
MATTHEW GONZALES	AGENT	17476856	YES		08/16/2016
TERESA JONES	AGENT	13963139	YES		08/16/2016
TINA DARENSBOURG	AGENT	17663708	YES		08/16/2016
JULIAN ABREGO	AGENT	6983606	YES		08/16/2016
MARK MARTINEZ	AGENT	16384223	YES		08/16/2016
KRISELL MARTINEZ	AGENT	17659685	YES		08/16/2016

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