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Secretary of State SI -550 <br />Statement of Information <br />(California Stock, Agricultural <br />Cooperative and Foreign Corporations) <br />IMPORTANT — Read instructions before completing this form. <br />Fees (Filing plus Disclosure)– $25.00; - <br />Copy Fees – First page $1.00; each attachment page $0.50; <br />• Certification Fee - $5.00 plus copy fees <br />•1:8='650101 <br />FILE® <br />Secretary of.Stat® <br />State of Calwomle <br />AUG 2 3 2018 <br />1. Corporetlon NamB (EMerthe ermctnema of Sha corporation es Bis recerded with the Caft aP2. <br />p �.•7 t� '1� t�I'KT a . o I a1 <br />SevetaryofState. Note: Ifyou registered In Califomia using an assumed name, see trsWCUMs.) This Pace For Office Use O ly <br />CARE AMBULANCE SERVICE, INC. 7 -Digit Secretary of state File Number. <br />C1432655 <br />C,. -I..-- Aww.A«-A <br />a. street Address of PdndPal Executive OBke-Dor HIM a P.O. Box <br />City (An eebrenfalions) <br />stem <br />'tip Code <br />1517 West Braden Court <br />Orange <br />CA <br />92868 <br />IS. Melling Address of Corporation lftif/arent than Item so <br />City (no abbreviations) <br />Stele <br />Zip Code <br />e Street Address of Pdndpal California Office, if any and B different than item tie- Do not list a P.O. Box <br />Ciy(w abbreviations) <br />Slate <br />Mp Code <br />1517 West Braden Court <br />Orange <br />CA <br />92868 <br />.4. Officers The Corporation Is required to list all three of the dRcers sol forth below. An additional title for the Chief Executive Officer and unlet <br />Financial ORder may be added; however. Ne preprinted tides on this form must not be altered, <br />Chief Executive Omeed First Name <br />Middle Name <br />lest Name <br />Suffixe. <br />Troy <br />city (w chbreuietlens) <br />Hagen <br />Zip fade <br />Address <br />Cily(noebbroviatlons) <br />State <br />tip Code <br />1517 West Braden Colirt <br />Orange <br />CA <br />I 92868 <br />IS. Secretary FIrsl Noma <br />Middle Name <br />Last Name <br />suffix <br />Brian <br />M, <br />Richmond <br />Address _ <br />City (no ebbravlatlons) <br />state <br />tip Code <br />1517 West Braden Court <br />Orange <br />CA <br />92868 <br />. M Chief Financial Omeed Fust Name• <br />MWdie theme - <br />last Name <br />Sax <br />All <br />Mian <br />Address <br />City (no abbreviations) <br />state <br />Zip Code ' <br />1517 West Braden CDurt <br />Orange <br />CA <br />92.868 <br />5. Director(s) Celltdmle Smoa and A96dultuM Goopannin corporations ONLY. Rem da: vw reasr uta name vnv uavna oma' uo u. -A. n A,o , <br />r.rn.reA.............I wra .- nmol Oto.nmafal And addrn... on Form 56550A fees iMWdanal. <br />a First Name <br />. mdde Name <br />last Name <br />Stax <br />Rick <br />city (w chbreuietlens) <br />Richardson <br />Zip fade <br />Address <br />CIN Ino abbreviation) <br />am <br />Zip Code <br />1517 West Braden Court <br />Orange <br />CA <br />1 92868 <br />b. Number orvaean des MUM Board of Diretlars, gam L -1 . <br />S. Service of Process (Must provide either Individual OR Corporation.) <br />tunnnni tet _ rn-Neta Itnmc an Anti Rh,mr¢ Must inv ude aeenra nel name end Caffiamla street address. <br />a. Cathode Agents Fist Name(Ifegentis not a corporation) <br />Middle Name <br />Last Name <br />six <br />b. Street Address of agent is not a corporation)- Do not entero P.O. Box <br />city (w chbreuietlens) <br />Stata <br />CA <br />Zip fade <br />CORPORATION-ComptateItemsconly. OteyIlltlde the name or IDs regsmrea agent Oorport on. <br />Fo. colgoMa Re&lorad Corporate Assets Name gfagent is a wMand on)-Dn not remptete Siem 6a dr So <br />C T Corporation System <br />7. Type of Business <br />Desdba the type of business or services of the Corpmagon <br />MEDICAL TRANSPORTATION <br />S. The Information contained herein, Including In any attachments, Is true and correct. <br />� p' <br />08-23-2018 Brian M. Richmond Secretary <br />Date Type or Print Nome of Person Completing cue Farm • 'nue Signature <br />56550 (REV 0112017) II � 2017 California Se6vtary of State <br />www.sta.ta.gwfousiflass(ba <br />250-206 <br />