Form 5500 · Employee benefit plan · LEBANON, PA
LEBANON INTERNAL MEDICINE ASSOCIATES, P.C.
The filing calls this plan LEBANON INTERNAL MEDICINE ASSOCIATES, P.C. EMPLOYEE BENEFIT PLAN.
LEBANON INTERNAL MEDICINE ASSOCIATES, P.C. of LEBANON, PA spreads its employee benefits across 5 insurance carriers, according to its Form 5500 Schedule A. Its broker of record is ACRISURE, LLC. Coverage is written through STANDARD INSURANCE COMPANY and 4 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 23-1899529 · plan 502 · plan year 2025, filed Apr 2, 2026
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How this plan is funded
Funding not settled by the filing
The filing does not report enough to settle how this plan pays for benefits.
The filing carries code 4S: this plan is filing again after previously being exempt.
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.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
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 5 insured contracts covering dental, vision, life and disability; the largest, with STANDARD INSURANCE COMPANY, covers 78 people.
The filing declares dental, vision, life, disability and health. Health appears with no insured contract on Schedule A. That coverage may be self-funded, or placed with a carrier that is not on this filing.
Reported premium across the insured contracts is $137,449, with $11,862 in disclosed broker commissions — about 8.6% of premium.
The most recent policy period ended in December, and the plan year ends June 30. Group contracts typically renew on that annual cycle.
ACRISURE, LLC is the broker of record on 1 of the 5 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| STANDARD INSURANCE COMPANY | Disability | 78 | Jan 1, 2025 | $43,729 | $4,465 |
| AMERICAN UNITED LIFE INSURANCE COMPANY | Disability | 68 | Jan 1, 2025 | $36,258 | $3,328 |
| DELTA DENTAL OF PENNSYLVANIA | Dental | 113 | Jan 1, 2025 | $34,793 | $2,435 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Life | 78 | Jan 1, 2025 | $16,340 | $1,634 |
| NVA | Vision | 118 | Jan 1, 2025 | $6,329 | $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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