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
DELZIA PEARL JONES	AGENT	2433950		YES	03/21/2016
RICHARD KYLE DEARING	AGENT	16838266		YES	03/21/2016
SANDRA MICHELLE THOMAS	AGENT	12835174		YES	03/21/2016
J TIMOTHY CAPPEL	AGENT	1853568		YES	03/21/2016
TSHAKA M REESE	AGENT	3927841		YES	03/21/2016
KATHRYN M FUCHS	AGENT	6610754		YES	03/21/2016
LYTORIA WHITFIELD	AGENT	12366248		YES	03/21/2016
ROBERT MICHAEL TEAGUE	AGENT	7450198		YES	03/21/2016
TRISTAN M GAY	AGENT	11446109		YES	03/21/2016
WILLIAM ALBERT ROLLINSON	AGENT	8201394		YES	03/21/2016
MATHEW SCOTT REGENSTRIEF	AGENT	9721672		YES	03/21/2016
GENE R WAGNER	AGENT	715110		YES	03/21/2016
SIXTO A WARD	AGENT	16371805		YES	03/21/2016
MARNEE LYNN SCHULLER	AGENT	9548346		YES	03/21/2016
TODD WINTERROWD	AGENT	17319504		YES	03/21/2016

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