0001679022-18-000002.txt : 20180627 0001679022-18-000002.hdr.sgml : 20180627 20180627113742 ACCESSION NUMBER: 0001679022-18-000002 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20180627 DATE AS OF CHANGE: 20180627 EFFECTIVENESS DATE: 20180627 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: 021-315517 FILM NUMBER: 18920914 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 X0708 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 General Partner of Issuer. 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 2018-01-01 false true false 0 Indefinite 0 Indefinite false 6 0 0 0 false Convenience Store Insurance Holdings, LLC /s/ Gary Zimmerman Gary Zimmerman Secretary 2018-06-27