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
JOHN L NELSON	AGENT	16771635	YES		3/17/2016
NATASHA A NURSE	AGENT	7049468	YES		3/17/2016
MICHAEL A O REILLY	AGENT	7013910	YES		3/17/2016
MAGALIE J ODERA	AGENT	3626765	YES		3/17/2016
BRANDON A OJALA	AGENT	8854262	YES		3/17/2016
ERIC L OLSON	AGENT	6507132	YES		3/17/2016
LAURA E ORNELAS	AGENT	17215952	YES		3/17/2016
MICHAEL S ORR	AGENT	5747901	YES		3/17/2016
TOMMY PEREIRA	AGENT	17659247	YES		3/17/2016
SONIA I PEREZ	AGENT	17676506	YES		3/17/2016
JESSICA A PETERSON	AGENT	15084591	YES		3/17/2016
PAUL W PETERSON	AGENT	9216719	YES		3/17/2016
DANY A PINEDA	AGENT	8672893	YES		3/17/2016
GREGORY PINO	AGENT	17653862	YES		3/17/2016
RODECIA C PITTER	AGENT	8671370	YES		3/17/2016

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