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
PETER J SOWRY	AGENT	591607		YES	03/24/2016
CHRIS M ROBISON	AGENT	9787417		YES	03/24/2016
CYDAVIA SHEEHY	AGENT	16741237		YES	03/24/2016
ANTONIA PILAR COUVERTIER	AGENT	17036253		YES	03/24/2016
LEANDRO RELOBA	AGENT	17335451		YES	03/24/2016
FELICIA L RAWLS	AGENT	15299423		YES	03/24/2016
MATTHEW ROGERS	AGENT	17327299		YES	03/24/2016
JUNE KIM	AGENT	16726385		YES	03/24/2016
QUASHALA M DAY	AGENT	17329918		YES	03/24/2016
KUJUANA LATRIECE NELSON	AGENT	8261354		YES	03/24/2016
EUGENE THOMAS OREN SWISHER	AGENT	16362457		YES	03/24/2016
HUNG MINH NGUYEN	AGENT	17007663		YES	03/24/2016
RYAN DAVID WALSH	AGENT	8086059		YES	03/24/2016
RAUL BROWN	AGENT	17346298		YES	03/24/2016
JENNIFER LYN MACKEY	AGENT	16985299		YES	03/24/2016

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