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
JEAN-MARC MICHEL	AGENT	14419803		YES	03/18/2016
ANTONIO ARMANDO CASTILLO	AGENT	15904485		YES	03/18/2016
WANDA SAINTIL	AGENT	11602764		YES	03/18/2016
LUCILLE ROSEMARY FARINA	AGENT	1026834		YES	03/18/2016
THOMAS WARD BROWN	AGENT	9289478		YES	03/18/2016
KATHI E BURNEY	AGENT	8637685		YES	03/18/2016
MONIQUE SHAWNTIA TOOKES	AGENT	8646016		YES	03/18/2016
JAMES ANTHONY FLAGELLA	AGENT	2062711		YES	03/18/2016
KATHY A HARTMANN	AGENT	481867		YES	03/18/2016
THADETTA ROGENIA SYLVESTER	AGENT	17335443		YES	03/18/2016
MELINDA SUE PECK	AGENT	8501901		YES	03/18/2016
FLORETTA BEATRICE STEWART	AGENT	8736011		YES	03/18/2016
DORCAS L MC CRAE	AGENT	15704790		YES	03/18/2016
WILLIAM EMERY LIVINGSTON	AGENT	14983699		YES	03/18/2016
DELORAS VIOLA RIVERS	AGENT	11171989		YES	03/18/2016

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