Form 5500 · Employee benefit plan · ELMORA, PA
LIFESTYLE SUPPORT SERVICES, INC
The filing calls this plan LIFESTYLE SUPPORT SERVICES, INC GROUP LIFE & AD&D.
LIFESTYLE SUPPORT SERVICES, INC of ELMORA, PA is a 152-participant health care and social assistance employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is CBIZ BENEFITS & INS SERVICES INC. Coverage is written through EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA and 2 other carriers. The plan's most recent policy period ended in June.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 25-1808601 · plan 501 · plan year 2025, filed Jan 21, 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.
Benefits declared on this filing
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 3 insured contracts covering health, dental, vision, life and disability; the largest, with EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA, covers 153 people.
Reported premium across the insured contracts is $154,914, with $14,068 in disclosed broker commissions — about 9.1% of premium.
The most recent policy period ended in June, and the plan year ends June 30. Group contracts typically renew on that annual cycle.
CBIZ BENEFITS & INS SERVICES INC is the broker of record on 1 of the 3 contracts; the rest name a different broker or none.
3 carriers appear on the filing, including EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA, UPMC HEALTH BENEFITS and VISION BENEFITS OF AMERICA. EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| EQUITABLE FINANCIAL LIFE INSURANCE COMPANY OF AMERICA | Life, Disability | 153 | Jul 1, 2025 | $81,805 | $8,395 |
| UPMC HEALTH BENEFITS | Health, Dental | 164 | Jul 1, 2025 | $56,925 | $5,673 |
| VISION BENEFITS OF AMERICA | Vision | 118 | Jul 1, 2025 | $16,184 | $0 |
Premium and claims on this contract
VISION BENEFITS OF AMERICA, contract 1591. For the contract year on this filing, the carrier reported $16,184 in premium earned and $7,613 in claims incurred. Dividing one by the other gives 47%.
- VISION BENEFITS OF AMERICA, contract 1591 reported $8,571 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
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.
Reported to OSHA
Reported to OSHA for 2025: 172 employees, 5 recordable cases, 506 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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