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SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 401k Plan overview

Plan NameSERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM
Plan identification number 509

SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

SERVICESOURCE, INC. has sponsored the creation of one or more 401k plans.

Company Name:SERVICESOURCE, INC.
Employer identification number (EIN):540901256
NAIC Classification:624310
NAIC Description:Vocational Rehabilitation Services

Additional information about SERVICESOURCE, INC.

Jurisdiction of Incorporation: Virginia Secretary of State
Incorporation Date: 1971-12-03
Company Identification Number: 0135311
Legal Registered Office Address: 10467 WHITE GRANITE DRIVE

OAKTON
United States of America (USA)
22124-2763

More information about SERVICESOURCE, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5092023-07-01NGOC-ANH TRAN2025-01-22
5092022-07-01NGOC-ANH TRAN2024-01-23
5092021-07-01NATE HOOVER2022-11-16
5092020-07-01NGOC-ANH TRAN2022-03-21
5092019-07-01CRYSTAL WHEELER2020-12-22
5092018-07-01CRYSTAL WHEELER2020-02-03
5092017-07-01
5092016-07-01
5092015-07-01TASHIA MALLETTE
5092014-07-01TASHIA MALLETTE
5092013-07-01TASHIA MALLETTE
5092012-07-01TASHIA MALLETTE
5092012-01-01TASHIA MALLETTE
5092011-01-01TASHA N MALLELTE
5092010-01-01CHALLIE DUNN THOMAS CHANG2011-07-11
5092009-01-01BERTHA PARBEY THOMAS CHANG2010-07-23

Form 5500 Responses for SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM

2023: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2023 form 5500 responses
2023-07-01Type of plan entitySingle employer plan
2023-07-01Plan funding arrangement – InsuranceYes
2023-07-01Plan benefit arrangement – InsuranceYes
2022: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan benefit arrangement – InsuranceYes
2021: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – InsuranceYes
2020: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – InsuranceYes
2019: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – InsuranceYes
2018: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – InsuranceYes
2017: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – InsuranceYes
2016: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – InsuranceYes
2015: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – General assets of the sponsorYes
2015-07-01Plan benefit arrangement – General assets of the sponsorYes
2014: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan benefit arrangement – InsuranceYes
2013: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan benefit arrangement – InsuranceYes
2012: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – General assets of the sponsorYes
2012-07-01Plan benefit arrangement – General assets of the sponsorYes
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract numberHC110476
Policy instance 3
Insurance contract or identification numberHC110476
Number of Individuals Covered1918
Insurance policy start date2023-07-01
Insurance policy end date2024-06-30
Total amount of commissions paid to insurance brokerUSD $14,535
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedHOSPITAL, CRITICAL ILLNESS, ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $212,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number167587
Policy instance 2
Insurance contract or identification number167587
Number of Individuals Covered1918
Insurance policy start date2023-07-01
Insurance policy end date2024-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $27,864
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3340925
Policy instance 1
Insurance contract or identification number3340925
Number of Individuals Covered1033
Insurance policy start date2023-07-01
Insurance policy end date2024-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,888,926
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberHC960222
Policy instance 3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number167587
Policy instance 2
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3340925
Policy instance 1
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberHC960222
Policy instance 3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number167587
Policy instance 2
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3340925
Policy instance 1
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK969904
Policy instance 4
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK969904
Policy instance 3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number167587
Policy instance 2
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3340925
Policy instance 1
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3340925
Policy instance 1
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3340925
Policy instance 1
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3340925
Policy instance 1
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number834926
Policy instance 1
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number834926
Policy instance 1

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