N

State of California
Secretary of State
Statement of Information

G182182

(Domestic Nonprofit, Credit Union and General Cooperative Corporations)

FILED

Filing Fee: $20.00. If this is an amendment, see instructions.
IMPORTANT – READ INSTRUCTIONS BEFORE COMPLETING THIS FORM
1. CORPORATE NAME

In the office of the Secretary of State
of the State of California

WHITTIER PREGNANCY CARE CLINIC, INC.

NOV-15 2018

2. CALIFORNIA CORPORATE NUMBER

C1571079

This Space for Filing Use Only

Complete Principal Office Address (Do not abbreviate the name of the city. Item 3 cannot be a P.O. Box.)
3.

STREET ADDRESS OF PRINCIPAL OFFICE IN CALIFORNIA, IF ANY

CITY

STATE

ZIP CODE

CITY

STATE

ZIP CODE

16147 WHITTIER BLVD., WHITTIER, CA 90603
4.

MAILING ADDRESS OF THE CORPORATION

16147 WHITTIER BLVD., WHITTIER, CA 90603
5.

EMAIL ADDRESS FOR RECEIVING STATUTORY NOTIFICATIONS

Names and Complete Addresses of the Following Officers (The corporation must list these three officers. A comparable title for the specific
officer may be added; however, the preprinted titles on this form must not be altered.)
5.

CHIEF EXECUTIVE OFFICER/

JEANETTE KUIPHOF
6.

SECRETARY

ADDRESS

SARAH FERRARO
7.

ADDRESS

CITY

STATE

ZIP CODE

CITY

STATE

ZIP CODE

CITY

STATE

ZIP CODE

15429 PLACID DR., LA MIRADA, CA 90638
138 LOCUST ST., BREA, CA 92821

CHIEF FINANCIAL OFFICER/

VALERIE SULLIVAN

ADDRESS

10428 POUNDS AVE., WHITTIER, CA 90603

Agent for Service of Process If the agent is an individual, the agent must reside in California and Item 9 must be completed with a California street
address, a P.O. Box address is not acceptable. If the agent is another corporation, the agent must have on file with the California Secretary of State a
certificate pursuant to California Corporations Code section 1505 and Item 9 must be left blank.
8.

NAME OF AGENT FOR SERVICE OF PROCESS [Note: The person designated as the corporation's agent MUST have agreed to act in that capacity prior to the designation.]

JEANETTE KUIPHOF
9.

STREET ADDRESS OF AGENT FOR SERVICE OF PROCESS IN CALIFORNIA, IF AN INDIVIDUAL

CITY

STATE

ZIP CODE

15429 PLACID DR., LA MIRADA, CA 90638
Common Interest Developments
10.

Check here if the corporation is an association formed to manage a common interest development under the Davis-Stirling Common Interest
Development Act, (California Civil Code section 4000, et seq.) or under the Commercial and Industrial Common Interest Development Act,
(California Civil Code section 6500, et seq.). The corporation must file a Statement by Common Interest Development Association (Form SI-CID) as
required by California Civil Code sections 5405(a) and 6760(a). Please see instructions on the reverse side of this form.

11. THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT.

11/15/2018
DATE
SI-100 (REV 01/2016)

JEANETTE KUIPHOF
TYPE/PRINT NAME OF PERSON COMPLETING FORM

PRESIDENT/CEO
TITLE

SIGNATURE
APPROVED BY SECRETARY OF STATE