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 WEST MAIN STREET
Address 2:
City:	LOUISVILLE
State:	KY
Zip:	40202
Phone:	502-580-1000
Fax:
Business Web Site Address:
Business Email Address:	JBRADY8@HUMANA.COM
Mailing Address
Address 1:	500 WEST 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
CAVAZOS, MR. GUILLERMO M.	AGENT	1039584		YES	11/3/2017
CEDENO, MR. ROBERT JOHN	AGENT	18504074	YES		11/3/2017
CHAMPION, MR. GILBERT S	AGENT	16301712	YES		11/3/2017
CHANDLER, MR. WILLIAM A	AGENT	11612425	YES		11/3/2017
CHARDON, MR. JULIO A.	AGENT	16570859	YES		11/3/2017
CHARLES, MS. DESTINY RA'SHAE	AGENT	18134456	YES		11/3/2017
CHARLTON, MS. JOHNNISHA	AGENT	18473992	YES		11/3/2017
CHARLTON, MS. SHANESHIA	AGENT	17864537	YES		11/3/2017
CHAVARRIA, MR. FLAVIO D	AGENT	17705227	YES		11/3/2017
CHEVALIER, MS. SHAUNTELLE L.	AGENT	18067524	YES		11/3/2017
CHIAFFARANO, MS. ASUNCION CARI	AGENT	8660963		YES	11/3/2017
CHINCHILLA, MS. BETHENEY	AGENT	18512295	YES		11/3/2017
CHIODO, MR. FRANCES M (FRAN)	AGENT	14419800	YES		11/3/2017
CHRISTOPHER, MR. LAVELL K	AGENT	18504056	YES		11/3/2017
CHUEZ, MR. LUIS A.	AGENT	16992528		YES	11/3/2017

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:	JENNIFER BRADY
Title:	PROJECT MANAGER
Phone Number:	502-471-9094
Email Address:	JBRADY8@HUMANA.COM