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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

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
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

Plan Statistics for SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM

401k plan membership statisitcs for SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM

Measure Date Value
2023: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2023 401k membership
Total participants, beginning-of-year2023-07-011,789
Total number of active participants reported on line 7a of the Form 55002023-07-011,918
Number of retired or separated participants receiving benefits2023-07-010
Number of other retired or separated participants entitled to future benefits2023-07-010
Total of all active and inactive participants2023-07-011,918
Number of employers contributing to the scheme2023-07-010
2022: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2022 401k membership
Total participants, beginning-of-year2022-07-011,791
Total number of active participants reported on line 7a of the Form 55002022-07-011,789
Number of retired or separated participants receiving benefits2022-07-010
Number of other retired or separated participants entitled to future benefits2022-07-010
Total of all active and inactive participants2022-07-011,789
Number of employers contributing to the scheme2022-07-010
2021: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2021 401k membership
Total participants, beginning-of-year2021-07-011,709
Total number of active participants reported on line 7a of the Form 55002021-07-011,791
Number of retired or separated participants receiving benefits2021-07-010
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-011,791
Number of employers contributing to the scheme2021-07-010
2020: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2020 401k membership
Total participants, beginning-of-year2020-07-011,097
Total number of active participants reported on line 7a of the Form 55002020-07-011,709
Number of retired or separated participants receiving benefits2020-07-010
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-011,709
Number of employers contributing to the scheme2020-07-010
2017: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2017 401k membership
Total participants, beginning-of-year2017-07-011,332
Total number of active participants reported on line 7a of the Form 55002017-07-011,034
Number of retired or separated participants receiving benefits2017-07-010
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-011,034
Number of employers contributing to the scheme2017-07-010
2016: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2016 401k membership
Total participants, beginning-of-year2016-07-011,332
Total number of active participants reported on line 7a of the Form 55002016-07-011,332
Number of retired or separated participants receiving benefits2016-07-010
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-011,332
2015: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2015 401k membership
Total participants, beginning-of-year2015-07-011,332
Total number of active participants reported on line 7a of the Form 55002015-07-011,332
Number of retired or separated participants receiving benefits2015-07-010
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-011,332
2014: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2014 401k membership
Total participants, beginning-of-year2014-07-011,176
Total number of active participants reported on line 7a of the Form 55002014-07-011,332
Number of retired or separated participants receiving benefits2014-07-010
Number of other retired or separated participants entitled to future benefits2014-07-010
Total of all active and inactive participants2014-07-011,332
2013: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2013 401k membership
Total participants, beginning-of-year2013-07-011,131
Total number of active participants reported on line 7a of the Form 55002013-07-011,176
Number of retired or separated participants receiving benefits2013-07-010
Number of other retired or separated participants entitled to future benefits2013-07-010
Total of all active and inactive participants2013-07-011,176
2012: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2012 401k membership
Total participants, beginning-of-year2012-07-011,131
Total number of active participants reported on line 7a of the Form 55002012-07-011,131
Number of retired or separated participants receiving benefits2012-07-010
Number of other retired or separated participants entitled to future benefits2012-07-010
Total of all active and inactive participants2012-07-011,131
Total participants, beginning-of-year2012-01-011,535
Total number of active participants reported on line 7a of the Form 55002012-01-011,176
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-011,176
2011: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2011 401k membership
Total participants, beginning-of-year2011-01-011,535
Total number of active participants reported on line 7a of the Form 55002011-01-011,535
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-011,535
2010: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2010 401k membership
Total participants, beginning-of-year2010-01-01956
Total number of active participants reported on line 7a of the Form 55002010-01-011,535
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-011,535
2009: SERVICESOURCE, INC. EMPLOYEE ASSISTANCE PROGRAM 2009 401k membership
Total participants, beginning-of-year2009-01-01366
Total number of active participants reported on line 7a of the Form 55002009-01-012,537
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-012,537

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
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
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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