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
MERCEDES GRANADOS	AGENT	7400883		YES	03/22/2016
MARTHA CRUZ	AGENT	8102286		YES	03/22/2016
WILLIAM LEE WALLICK	AGENT	9663854		YES	03/22/2016
HECTOR DANIEL PULIDO	AGENT	10148825		YES	03/22/2016
YVONNE MARIE ROMAN	AGENT	8380323		YES	03/22/2016
RICARDO SALAZAR	AGENT	1099564		YES	03/22/2016
ARTHUR MARTINEZ	AGENT	17355409		YES	03/22/2016
JENNIFER LEI ORTIZ	AGENT	17382446		YES	03/22/2016
AMON COLE PRATHER	AGENT	9335594		YES	03/22/2016
PAMELA JEAN TRIBUE	AGENT	9335562		YES	03/22/2016
ISMAEL ESTRADA	AGENT	7266948		YES	03/22/2016
STEPHEN CRAIG JOHNSON	AGENT	5310567		YES	03/22/2016
GORDON J LARSON	AGENT	16371802		YES	03/22/2016
ADAM MARK GLESMANN	AGENT	16564672		YES	03/22/2016
HOWARD D PETERS	AGENT	272564		YES	03/22/2016

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