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
LONDIE JAMAINE FULLER-SPENCER	AGENT	15031321		YES	03/22/2016
THOMAS GERMSCHEID	AGENT	8762793		YES	03/22/2016
TERESA CHARLENE SHOOK	AGENT	8497968		YES	03/22/2016
KRISTIE J VEENSTRA	AGENT	4775851		YES	03/22/2016
JASON LEACH	AGENT	12854960		YES	03/22/2016
JOSEPH LOUIS RAMIREZ	AGENT	7116431		YES	03/22/2016
PATRICIA ANN CLAUDE	AGENT	542734		YES	03/22/2016
DOUG STEVENS	AGENT	755958		YES	03/22/2016
WILLIAM M HOWARD	AGENT	390719		YES	03/22/2016
MIYA FARMER	AGENT	17341333		YES	03/22/2016
KEINA WAGNER	AGENT	16691820		YES	03/22/2016
ROBERT ARTHUR LANGE	AGENT	16783583		YES	03/22/2016
CASEY JOHNS	AGENT	17319513		YES	03/22/2016
STEVEN M SCHMIT	AGENT	17026059		YES	03/22/2016
CARLY ANN HANNEY	AGENT	16689630		YES	03/22/2016

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