Employer
Icon Legacy Custom Modular Homes, L.L.C.
246 Sand Hill Road, Selinsgrove, PA 17870 · EIN 32-0223154 · Jul 1, 2024 to Jun 30, 2025
Plan year 2024
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Schedule A
Direct compensation
Coverage contracts on the filing. If the carrier did not provide Schedule A, the row is listed with that note.
| Coverage | Carrier | Broker | Lives | Direct comp |
|---|---|---|---|---|
| Stop-loss | HM Life Insurance Company | — | 85 | Comp not disclosed Premium $480,858 |
Schedule C
Additional compensation
Plan-paid amounts to each named party on the filing, with the role they reported. This is not a carrier commission and is not added to Schedule A.
Visible subtotal $39,557
| Party | Type | Amount | $ / Enrolled / Year |
|---|---|---|---|
| Sholley Agency, Inc. | Broker | $31,388 | $352.67 |
| The Benecon Group | Broker | $30,563 | $343.40 |
| Capital Bluecross | Admin | $-22,394 | $-251.62 |