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:	5024762445
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
LUIS A CINTRON GAZTAMBIDE	AGENT	9499344	YES		03/16/2016
MARK W CLARK	AGENT	5322635	YES		03/16/2016
JASMINE Y COHEN	AGENT	8689115	YES		03/16/2016
EARL COLEMAN	AGENT	16708948	YES		03/16/2016
KYLA L COOPER	AGENT	8398918	YES		03/16/2016
PATRICK K DAVIDSON	AGENT	16176546	YES		03/16/2016
DAVINA L DAVIS	AGENT	8903016	YES		03/16/2016
JOHN E DAVIS	AGENT	7867583	YES		03/16/2016
KRISEREEN M DELA CRUZ	AGENT	17686992	YES		03/16/2016
MICHAEL DELGADO	AGENT	17320650	YES		03/16/2016
NICHOLAS S DEMOE	AGENT	16289192	YES		03/16/2016
BAO-TRAN N DO	AGENT	17657046	YES		03/16/2016
KAY L DREYER	AGENT	368050	YES		03/16/2016
MARK E DUNCAN	AGENT	9652511	YES		03/16/2016
CHRISTIE DURAND	AGENT	17323494	YES		03/16/2016

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