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
JOMORE CURTIS CURRIE	AGENT	9140967		YES	03/22/2016
DORA LISA RICHARDS	AGENT	6744554		YES	03/22/2016
MARK STANLEY LEE	AGENT	2985895		YES	03/22/2016
RAFAEL MIRANDA GOVEA	AGENT	15104388		YES	03/22/2016
DANIEL FLORES	AGENT	6744836		YES	03/22/2016
CANDY LYNN MCGINLEY	AGENT	17037120		YES	03/22/2016
DAVID VAN CROSS	AGENT	583810		YES	03/22/2016
STACIE MARIE SODDY	AGENT	6499908		YES	03/22/2016
BRIAN SHINOHARA	AGENT	15964295		YES	03/22/2016
DAVID EHRENFRIED	AGENT	3298437		YES	03/22/2016
CARLOS EDGAR RIVERA	AGENT	17305809		YES	03/22/2016
JOEL ALEXANDER NOGUEIRA	AGENT	16303305		YES	03/22/2016
JENNIFER TRUE	AGENT	11582842		YES	03/22/2016
ROBERT HODGES	AGENT	3529355		YES	03/22/2016
SCHANDIA KAREN WILLIAMS	AGENT	15940602		YES	03/22/2016

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