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
FRAN ELIZABETH DENNIS	AGENT	2759191		YES	03/21/2016
SAHARA LANCE-LAWSON	AGENT	17028250		YES	03/21/2016
ROBERT H TURTON	AGENT	1738122		YES	03/21/2016
BARBARA ANNE WHITE	AGENT	510110		YES	03/21/2016
THOMAS TURPIN RICKETTS	AGENT	9904788		YES	03/21/2016
DAVID G WOHLGAMUTH	AGENT	1766172		YES	03/21/2016
SUSAN KAY GREENE	AGENT	76171		YES	03/21/2016
NICCOLE KNICKERBOCKER	AGENT	3518216		YES	03/21/2016
ANN MARIE CUSTER	AGENT	8607153		YES	03/21/2016
MELISSA MARIE WILLIS	AGENT	11163781		YES	03/21/2016
JASON RYAN REPP	AGENT	7882470		YES	03/21/2016
SUSAN J BRLETIC	AGENT	2256778		YES	03/21/2016
DESHAWNA R SIMS	AGENT	16330600		YES	03/21/2016
ADRIENNE H ROTH	AGENT	10165585		YES	03/21/2016
CRAIG K HANSEN	AGENT	998126		YES	03/21/2016

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