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| Plan Name | OSA SEPARATE TRUST |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | OSA |
| Employer identification number (EIN): | 830361341 |
| NAIC Classification: | 445120 |
| NAIC Description: | Convenience Stores |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2009-05-01 | ||||
| 501 | 2009-05-01 | ||||
| 501 | 2009-05-01 |
| Measure | Date | Value |
|---|---|---|
| 2009: OSA SEPARATE TRUST 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-05-01 | 2 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-05-01 | 0 |
| Number of retired or separated participants receiving benefits | 2009-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-05-01 | 0 |
| Total of all active and inactive participants | 2009-05-01 | 0 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-05-01 | 0 |
| Number of participants with account balances | 2009-05-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-05-01 | 0 |
| 2009: OSA SEPARATE TRUST 2009 form 5500 responses | ||
|---|---|---|
| 2009-05-01 | Type of plan entity | Single employer plan |
| 2009-05-01 | First time form 5500 has been submitted | Yes |
| 2009-05-01 | Submission has been amended | No |
| 2009-05-01 | This submission is the final filing | Yes |
| 2009-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-05-01 | Plan is a collectively bargained plan | No |
| 2009-05-01 | Plan funding arrangement – Trust | Yes |
| 2009-05-01 | Plan benefit arrangement - Trust | Yes |
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