TAX INFORMATION: IMPORTANT HEALTH COVERAGE TAX DOCUMENT (1095-C FORM)

According to new Federal requirements, you may receive a copy of your Form 1095-C upon request. This means that QuikTrip Corporation is no longer required to automatically furnish you a 1095-C.

If you live in California, New Jersey, Rhode Island, or Washington, DC, these same Federal requirements do not apply to you. QuikTrip Corporation will mail a paper form unless you have opted 
to receive your Form 1095-C electronically.

For “Active Employees”
If you are “Actively Employed”, and you would like a copy of your Form 1095-C, you
may access our benefits portal at https://qtbenefits.quiktrip.com or our external portal
at https://www.paperlessemployee.com/qt and download your Form 1095-C electronically.

If you live in one of the above states and wish to receive your form electronically in the future, you may use the link above to change your preference.

For “Former Employees/Retirees”
If you are no longer employed by QuikTrip Corporation or you are retired, and you would like to request a copy of your Form 1095-C, you may access our externalportal at 
https://www.paperlessemployee.com/qt.
Upon accessing our external portal, please authenticate your identity by logging in with a username and password and download your Form 1095-C electronically.

Questions
If you have additional questions or need further assistance, please contact the Benefits Department at:
Email: benefits@quiktrip.com
Phone: 833-449-2408