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
CRAIG ALAN ROGERS	AGENT	13105179		YES	03/24/2016
MONSERRATT RUVALCABA	AGENT	16756523		YES	03/24/2016
ASHLEIGH BULAK	AGENT	16309436		YES	03/24/2016
MARCELLA DOUGHERTY	AGENT	11410961		YES	03/24/2016
JASMIN ROSE TOVES	AGENT	10136584		YES	03/24/2016
JAMIE MARIE MISHLER	AGENT	15784153		YES	03/24/2016
JUAN SOLIS	AGENT	9910538		YES	03/24/2016
DAVID GARZA	AGENT	17744511		YES	03/24/2016
KAREN LORRAINE HILL	AGENT	17068854		YES	03/24/2016
MARVIN WILLIAM SHIRLEY	AGENT	17035923		YES	03/24/2016
ROMAN GABRIEL LEVARIO	AGENT	17084161		YES	03/24/2016
SHARON MARGARITA OSPINO	AGENT	15141844		YES	03/24/2016
DWAYNE R DASH	AGENT	10428846		YES	03/24/2016
VIOLETA ISMAIL	AGENT	17342049		YES	03/24/2016

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