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
RICHARD P MARKS	AGENT	16208269	YES		03/17/2016
ROBERT D MARTE	AGENT	7131068	YES		03/17/2016
KADEEM S MASON	AGENT	17658535	YES		03/17/2016
LOAR MAYES	AGENT	11712300	YES		03/17/2016
CHRISTOPHER MAYS	AGENT	15946161	YES		03/17/2016
THOMAS A MCCORMICK	AGENT	6505107	YES		03/17/2016
ROHAN C MCFARLANE	AGENT	8530754	YES		03/17/2016
JAMES M MCGUINESS	AGENT	2111739	YES		03/17/2016
RHEIANNA MCLEOD	AGENT	17699905	YES		03/17/2016
JUAN T MEDINA	AGENT	17064198	YES		03/17/2016
MARK MEDINA	AGENT	16684858	YES		03/17/2016
MONICA MELENDEZ RODRIGUEZ	AGENT	10389778	YES		03/17/2016
GAILDEN A MOORE	AGENT	16753218	YES		03/17/2016
PATRICIA MOORE	AGENT	17076377	YES		03/17/2016
ANGELIC J MURPHY	AGENT	17614926	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)
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