Laserfiche WebLink
Secretary of State SI -550 <br />Statement of Information 0p: <br />(California Stock, Agricultural iel <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 />1!8-1650101 <br />FILE® <br />Secretary of.State <br />State of Califomi® <br />AUG 2 3 2018 <br />Certification Fee - $5,00 plus copy fees ) I !� /� I N <br />1. Corporation Name (Enter the exact name of the corporagan as it Is recorded Win the California 381,SD I Iv't' 1 CC f t a�j , e12 -t <br />Secretary of State. Note: If you registered In California using an assumed name, see Instructions) � Thl3 u1pace For Office Use Drily <br />CARE AMBULANCE SERVICE, INC, 2. 7 -Digit Secretary of State File Number <br />C1432655 <br />3. Business Addresses <br />a. Street Address of Principal Executive Office - Do not list a P.O. Box <br />City (no abbreviations) <br />state'Zip <br />Code <br />1517 West Braden Court <br />Orange <br />CA <br />92868 <br />Is. Mailing Address of Corporation, If different than Item 3a <br />City(no abbreviations) <br />state <br />Zip Code <br />C. Sheet Address of Principal California Office, if any and It different than Item 3a - Do not list a P.O. Boz <br />City (no abbreviation) <br />State <br />Zip 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 officers set forth below. An additional tiffe for the Chief Executive Officer and Chief <br />Financial Officer may be added: however. the Preprinted Was on this form must not be altered. <br />a. Chief Executive Omcerl First Name <br />Middle Name <br />Last Name <br />Suffix <br />Troy <br />City (no abbreviations) <br />Hagen <br />Zip Code <br />Address <br />City(no abbreviations) <br />State <br />Zlp Code <br />1517 West Braden Court <br />Orange <br />CA <br />92868 <br />Is. Secretary First Name <br />Mldtlle Name <br />Last Name <br />Suffix <br />Brian <br />M, <br />Richmond <br />AddreSSi7sWest Braden CDUrt — <br />City (no obbreviaScna) <br />Orange <br />Stele <br />CA <br />Zip Code <br />92868 <br />. c. Chief Financial Officer/ First Name <br />Middle Name <br />last Name <br />Suffix <br />Ali <br />Mian <br />Address <br />Cityabbreviations) <br />ane) <br />Code <br />1517 Braden Court <br />Ora(nge <br />CA <br />9 2 868 <br />S. Directors) California Stock and Agricultural Cooperative corporations ONLY', Item So: At lent one name and address must be listed. If the <br />Corporation has additional directors. enter the namefs) and addresses on Form SI -550A (see Inshuations). <br />e. First Name <br />. Middle Name <br />Last Name <br />Suffix <br />Rick <br />City (no abbreviations) <br />Richardson <br />Zip Code <br />Address - <br />City(no abbreviations) <br />State <br />Zip Code <br />1517 West Braden Court <br />Orange <br />CA <br />92868 <br />b. Number or Vecencies on the Board of Directors, u any _1 <br />U. tiomice Or PrOCOSS (Must provide either Individual OR Corporation.) ' <br />INDIVIDUAL— Complete Items Sa and Sb only. Must Include agent's full name and California street address. <br />e. California Agent's First Name (if agent Is not a corporation) <br />Middle Name <br />Last Name <br />Sumz <br />b. Street Address Of agent is not a corporation) - Do not enter a P.O. Box <br />City (no abbreviations) <br />State <br />CA <br />Zip Code <br />CORPORATION — Complete Item so only. Only include the name of Ore registered agent Corporation. <br />C <br />. Califomla Registered Corporate Agent's Name (If agent is a corporation) — Do not complete Item ea or eb <br />C T Corporation System <br />7. Type of Business ' <br />Describe the type of business or services of the Corporation <br />MEDICAL TRANSPORTATION <br />S. The Information contained herein, Including in any attachments, is true and correct. <br />e ���� P <br />08-23-2018 Brian M. Richmond � Secretary <br />Date Type or Print Name of Person Completing the re TIDe <br />Fa <br />8I-550 (REV 0112017) II 2017 California Secretary of State <br />vnemsos.ca.govlbusiness@e <br />