Form 5500 · Employee benefit plan · DUNKIRK, NY
LAKE SHORE SAVINGS BANK
The filing calls this plan LAKE SHORE SAVINGS BANK WELFARE BENEFITS PLAN.
LAKE SHORE SAVINGS BANK of DUNKIRK, NY is a 130-participant finance and insurance employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is LAWLEY BENEFITS GROUP LLC. Coverage is written through HIGHMARK WESTERN AND NORTHEASTERN NEW YORK INC. and 3 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 16-0516470 · plan 501 · plan year 2024, filed Oct 15, 2025
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
Also declared: death benefits.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 4 insured contracts covering health, dental, vision, life and disability; the largest, with HIGHMARK WESTERN AND NORTHEASTERN NEW YORK INC., covers 67 people.
Reported premium across the insured contracts is $889,449, with $41,758 in disclosed broker commissions — about 4.7% of premium.
The health contract's policy period ended in December, while at least one ancillary line's policy period ended in August. The plan is on a split renewal cycle.
LAWLEY BENEFITS GROUP LLC is the broker of record on 2 of the 4 contracts; the rest name a different broker or none.
4 carriers appear on the filing, including HIGHMARK WESTERN AND NORTHEASTERN NEW YORK INC., THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA, MUTUAL OF OMAHA INSURANCE COMPANY and FEDERAL INSURANCE COMPANY. HIGHMARK WESTERN AND NORTHEASTERN NEW YORK INC. writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| HIGHMARK WESTERN AND NORTHEASTERN NEW YORK INC. | Health | 67 | Jan 1, 2025 | $747,388 | $25,666 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | Dental, Vision, Life | 98 | Jan 1, 2025 | $128,972 | $14,129 |
| MUTUAL OF OMAHA INSURANCE COMPANY | Disability | 93 | Jan 1, 2025 | $13,089 | $1,963 |
| FEDERAL INSURANCE COMPANY | — | 116 | Aug 19, 2024 | — | $0 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
How this plan compares
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