401k Plan data: QUICK CHEK CORPORATION plan

QUICK CHEK CORPORATION 401k Plan overview

Plan Name	QUICK CHEK CORPORATION
Plan identification number	501

QUICK CHEK CORPORATION Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

QUICK CHEK CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: QUICK CHEK CORPORATION

Employer identification number (EIN): 221821697

NAIC Classification: 445120
NAIC Description: Convenience Stores

Additional information about QUICK CHEK CORPORATION

Jurisdiction of Incorporation: New Jersey Division of Revenue and Enterprise Services

Incorporation Date:

Company Identification Number: 7263455000

More information about QUICK CHEK CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan QUICK CHEK CORPORATION

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2011-01-01 NANCY RUMPF
501 2011-01-01 NANCY RUMPF 2020-04-06

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2011-01-01	NANCY RUMPF
501	2011-01-01	NANCY RUMPF	2020-04-06

Plan Statistics for QUICK CHEK CORPORATION

401k plan membership statisitcs for QUICK CHEK CORPORATION

Measure Date Value
2011: QUICK CHEK CORPORATION 2011 401k membership
Total participants, beginning-of-year 2011-01-01 955
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 952
Number of retired or separated participants receiving benefits 2011-01-01 3
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 955
Number of employers contributing to the scheme 2011-01-01 0

Measure	Date	Value
2011: QUICK CHEK CORPORATION 2011 401k membership
Total participants, beginning-of-year	2011-01-01	955
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	952
Number of retired or separated participants receiving benefits	2011-01-01	3
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	955
Number of employers contributing to the scheme	2011-01-01	0

Form 5500 Responses for QUICK CHEK CORPORATION

2011: QUICK CHEK CORPORATION 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 )

Policy contract number

8704-PAL

Policy instance

Insurance contract or identification number	8704-PAL
Number of Individuals Covered	222
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $8,160
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $81,596
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,160
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010133881

Policy instance

Insurance contract or identification number	000010133881
Number of Individuals Covered	1442
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $12,174
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $101,450
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,174
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000400001000

Policy instance

Insurance contract or identification number	000400001000
Number of Individuals Covered	380
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $8,640
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $71,997
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,640
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30015448

Policy instance

Insurance contract or identification number	30015448
Number of Individuals Covered	604
Insurance policy start date	2010-11-01
Insurance policy end date	2011-10-31
Total amount of commissions paid to insurance broker	USD $2,096
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $65,865
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,096
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	QUICK CHEK CORPORATION
Employer identification number (EIN):	221821697
NAIC Classification:	445120
NAIC Description:	Convenience Stores

Jurisdiction of Incorporation:	New Jersey Division of Revenue and Enterprise Services
Incorporation Date:
Company Identification Number:	7263455000