Notification of Changes for Business Entity
General Information
Business Entity Name:	HUMANA MARKETPOINT
Incorporation / Formation Date:
FEIN:	611343508
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	KY
County:	JEFFERSON
Business Address
Address 1:	500 W MAIN STREET
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 STREET
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
ROY ADAMS	AGENT	11582825		YES	08/11/2016
MARIA ALARCON	AGENT	17006627		YES	08/11/2016
DEBRA ANSTICE	AGENT	8710644		YES	08/11/2016
RICHARD BLACKFORD	AGENT	15782691		YES	08/11/2016
RACENE BOLTON-GRESHAM	AGENT	2342033		YES	08/11/2016
WENDY BORBON	AGENT	16475310		YES	08/11/2016
PAUL BROOKS	AGENT	17019989		YES	08/11/2016
DEVIN BROWN	AGENT	16105336		YES	08/11/2016
MARJORIE BRYANT	AGENT	1734892		YES	08/11/2016
JENNIFER BRYSON	AGENT	17345352		YES	08/11/2016
RAYMOND BURRELL	AGENT	17013200		YES	08/11/2016
JASMINE CARTER	AGENT	16986573		YES	08/11/2016
ERIC CHRISTIANSON	AGENT	6449722		YES	08/11/2016
PIERPAOLO CIFONE	AGENT	17001730		YES	08/11/2016
UE VONICA COHEN	AGENT	9289481		YES	08/11/2016

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