DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Employer Benefits Management Inc	DOIID	923271	NAIC NPN	15889492

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	8/3/2016	3/31/2026
Inactive	Non Resident	Agent	Health	8/3/2016	3/31/2026
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	3/7/2023	1/24/2025
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	3/7/2023	1/24/2025

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Cornutt, Harold Bruce	922692	Agent - Health	8/3/2016	3/31/2026
Inactive	Cornutt, Harold Bruce	922692	Agent - Life	8/3/2016	3/31/2026