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
ISABEL RIOS	AGENT	16319240		YES	03/17/2016
RICHARD ALAN HEALY	AGENT	431835		YES	03/17/2016
KIMBERLE SPENCE	EMPLOYEE	15935529		YES	03/17/2016
KENNETH E GLOVER	AGENT	17350045		YES	03/17/2016
IVETTE CAMACHO	AGENT	14939861		YES	03/17/2016
SUSANA L JAQUEZ	AGENT	8469684		YES	03/17/2016
GLEN PETER VANDERWALKER	AGENT	17026278		YES	03/17/2016
DIONE PATRICE VAZQUEZ	AGENT	16702001		YES	03/17/2016
PATRICIA ANN MOORE	AGENT	1018387		YES	03/17/2016
ANITA WARD	AGENT	3663985		YES	03/17/2016
CATHLEEN BARROW SHYERS	AGENT	5719699		YES	03/17/2016
VALERIE JAYNE TREMAINE	AGENT	8087584		YES	03/17/2016
MARCUS RODRIGUEZ	AGENT	9293317		YES	03/17/2016
MARLEA DENAY GWATHNEY	AGENT	7822228		YES	03/17/2016
COMFORT ESSIET	AGENT	15904474		YES	03/17/2016

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)	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