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
MELISSA SANCHEZ	AGENT	11405657	YES		3/17/16
ROBERTO SANCHEZ GARCIA	AGENT	17029201	YES		3/17/16
MELISSA M SANSONE	AGENT	17689310	YES		3/17/16
LIDIA G SEGURA	AGENT	12048054	YES		3/17/16
BENJAMIN D SEITZ	AGENT	16366487	YES		3/17/16
MIKENLAURE SIMILIEN	AGENT	8340473	YES		3/17/16
ILDIKO SIMON	AGENT	17507435	YES		3/17/16
RALPH A SIRMONS	AGENT	7543399	YES		3/17/16
STEVEN J SKELTON	AGENT	10583318	YES		3/17/16
ALAN J SMITH	AGENT	1739450	YES		3/17/16
JULIE SMITH	AGENT	17310465	YES		3/17/16
WILLIAM J SMITH	AGENT	1889543	YES		3/17/16
TERESITA D SOFFER	AGENT	2764603	YES		3/17/16
JUAN SOLIS	AGENT	17336685	YES		3/17/16
PHILIP C STEIN	AGENT	9037752	YES		3/17/16

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