0001679022-16-000001.txt : 20160707 0001679022-16-000001.hdr.sgml : 20160707 20160707140410 ACCESSION NUMBER: 0001679022-16-000001 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20160707 DATE AS OF CHANGE: 20160707 EFFECTIVENESS DATE: 20160707 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Convenience Store Insurance Holdings, LLC CENTRAL INDEX KEY: 0001679022 IRS NUMBER: 481274598 STATE OF INCORPORATION: DE FISCAL YEAR END: 1216 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-266519 FILM NUMBER: 161756202 BUSINESS ADDRESS: STREET 1: 5700 SIXTH AVENUE CITY: ALTOONA STATE: PA ZIP: 16602 BUSINESS PHONE: 8149415139 MAIL ADDRESS: STREET 1: 5700 SIXTH AVENUE CITY: ALTOONA STATE: PA ZIP: 16602 D 1 primary_doc.xml X0707 D LIVE 0001679022 Convenience Store Insurance Holdings, LLC 5700 SIXTH AVENUE ALTOONA PA PENNSYLVANIA 16602 8149415139 DELAWARE None None Limited Liability Company true L.L.C. PIE 5700 SIXTH AVENUE ALTOONA PA PENNSYLVANIA 16602 Executive Officer Manager Stephen G. Sheetz 5700 SIXTH AVENUE ALTOONA PA PENNSYLVANIA 16602 Executive Officer Stanton R. Sheetz 5700 SIXTH AVENUE ALTOONA PA PENNSYLVANIA 16602 Executive Officer Joseph S. Sheetz 5700 SIXTH AVENUE ALTOONA PA PENNSYLVANIA 16602 Executive Officer Retailing Decline to Disclose 06b false 2016-01-01 false true false 1000 Indefinite 0 Indefinite false 16 0 0 0 false Convenience Store Insurance Holdings, LLC Gary Zimmerman Gary Zimmerman Secretary 2016-07-07