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  5. MEDSTAR AMBULANCE, INC.

MEDSTAR AMBULANCE, INC.

Company Details

Entity Name: MEDSTAR AMBULANCE, INC.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Goodstanding
Date Formed: 16 Sep 1987
Company Number: CORP_54802803
File Number: 54802803
Type of Business: Business Corporations
Place of Formation: ILLINOIS

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
JJ45XW155KP5 2025-04-03 705 BRADBURY LN, SPARTA, IL, 62286, 2102, USA P. O. BOX 296, 705 BRADBURY LANE, SPARTA, IL, 62286, 0296, USA

Business Information
URL http://www.medstarems.net
Congressional District 12
State/Country of Incorporation IL, USA
Activation Date 2024-04-05
Initial Registration Date 2005-09-14
Entity Start Date 1981-08-01
Fiscal Year End Close Date Dec 31

Service Classifications
NAICS Codes 621910
Product and Service Codes V225

Points of Contacts
Electronic Business
Title PRIMARY POC
Name CHARLES R KELLEY
Role MR.
Address P. O. BOX 296, SPARTA, IL, 62286, 0296, USA
Title ALTERNATE POC
Name CHARLES R KELLEY
Role MR
Address P. O. BOX 296, SPARTA, IL, 62286, 0296, USA
Government Business
Title PRIMARY POC
Name CHARLES R KELLEY
Role MR.
Address P. O. BOX 296, SPARTA, IL, 62286, 0296, USA
Title ALTERNATE POC
Name CHARLES R KELLEY
Role MR
Address P. O. BOX 296, SPARTA, IL, 62286, 0296, USA
Past Performance
Title PRIMARY POC
Name CHARLES R KELLEY
Role MR
Address P. O. BOX 296, SPARTA, IL, 62286, 0296, USA
Title ALTERNATE POC
Name CHARLES R KELLEY
Role MR
Address P, O. BOX 296, 705 BRADBURY LANE, SPARTA, IL, 62286, 0296, USA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MEDSTAR AMBULANCE, INC. PREMIUM ONLY PLAN 2023 371221954 2024-07-23 MEDSTAR AMBULANCE, INC. 138
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1995-03-01
Business code 621900
Sponsor’s telephone number 6184435061
Plan sponsor’s mailing address 705 BRADBURY LANE, P.O. BOX 296, SPARTA, IL, 622860296
Plan sponsor’s address 705 BRADBURY LANE, P.O. BOX 296, SPARTA, IL, 622860296

Number of participants as of the end of the plan year
Active participants 203
MEDSTAR AMBULANCE, INC 401(K) PLAN 2023 371221954 2024-07-23 MEDSTAR AMBULANCE, INC 173
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2021-01-01
Business code 621900
Sponsor’s telephone number 6184435061
Plan sponsor’s address PO BOX 296, SPARTA, IL, 62286

Signature of
Role Plan administrator
Date 2024-07-23
Name of individual signing CHRIS HORNE
Valid signature Filed with authorized/valid electronic signature
MEDSTAR AMBULANCE, INC. PREMIUM ONLY PLAN 2022 371221954 2023-07-25 MEDSTAR AMBULANCE, INC. 158
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1995-03-01
Business code 621900
Sponsor’s telephone number 6184435061
Plan sponsor’s mailing address 705 BRADBURY LANE, P.O. BOX 296, SPARTA, IL, 622860296
Plan sponsor’s address 705 BRADBURY LANE, P.O. BOX 296, SPARTA, IL, 622860296

Number of participants as of the end of the plan year
Active participants 138
MEDSTAR AMBULANCE, INC. PREMIUM ONLY PLAN 2021 371221954 2022-07-22 MEDSTAR AMBULANCE, INC. 153
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1995-03-01
Business code 621900
Sponsor’s telephone number 6184435061
Plan sponsor’s mailing address 705 BRADBURY LANE, P.O. BOX 296, SPARTA, IL, 622860296
Plan sponsor’s address 705 BRADBURY LANE, P.O. BOX 296, SPARTA, IL, 622860296

Number of participants as of the end of the plan year
Active participants 158
MEDSTAR AMBULANCE 401(K) PLAN 2020 371221954 2021-08-27 MEDSTAR AMBULANCE 85
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621900
Sponsor’s telephone number 6184435061
Plan sponsor’s address 705 BRADBURY LANE, SPARTA, IL, 62286

Signature of
Role Plan administrator
Date 2021-08-27
Name of individual signing CINDY JONES
Valid signature Filed with authorized/valid electronic signature
MEDSTAR AMBULANCE, INC. PREMIUM ONLY PLAN 2020 371221954 2021-07-27 MEDSTAR AMBULANCE, INC. 131
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1995-03-01
Business code 621900
Sponsor’s telephone number 6184435061
Plan sponsor’s mailing address 705 BRADBURY LANE, P.O. BOX 296, SPARTA, IL, 622860296
Plan sponsor’s address 705 BRADBURY LANE, P.O. BOX 296, SPARTA, IL, 622860296

Number of participants as of the end of the plan year
Active participants 153
MEDSTAR AMBULANCE 401(K) PLAN 2019 371221954 2020-09-14 MEDSTAR AMBULANCE 85
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 621900
Sponsor’s telephone number 6184435061
Plan sponsor’s address 705 BRADBURY LANE, SPARTA, IL, 62286

Signature of
Role Plan administrator
Date 2020-09-14
Name of individual signing CINDY JONES
Valid signature Filed with authorized/valid electronic signature
MEDSTAR AMBULANCE, INC. PREMIUM ONLY PLAN 2019 371221954 2020-07-15 MEDSTAR AMBULANCE, INC. 135
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1995-03-01
Business code 621900
Sponsor’s telephone number 6184435061
Plan sponsor’s mailing address 705 BRADBURY LANE, P.O. BOX 296, SPARTA, IL, 622860296
Plan sponsor’s address 705 BRADBURY LANE, P.O. BOX 296, SPARTA, IL, 622860296

Number of participants as of the end of the plan year
Active participants 131
MEDSTAR AMBULANCE, INC. PREMIUM ONLY PLAN 2018 371221954 2019-07-16 MEDSTAR AMBULANCE, INC. 98
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1995-03-01
Business code 621900
Sponsor’s telephone number 6184435061
Plan sponsor’s mailing address 705 BRADBURY LANE, P.O. BOX 296, SPARTA, IL, 622860296
Plan sponsor’s address 705 BRADBURY LANE, P.O. BOX 296, SPARTA, IL, 622860296

Number of participants as of the end of the plan year
Active participants 135
MEDSTAR AMBULANCE, INC. PREMIUM ONLY PLAN 2017 371221954 2018-07-27 MEDSTAR AMBULANCE, INC. 100
File View Page
Three-digit plan number (PN) 501
Effective date of plan 1995-03-01
Business code 621900
Sponsor’s telephone number 6184435061
Plan sponsor’s mailing address 705 BRADBURY LANE, P.O. BOX 296, SPARTA, IL, 622860296
Plan sponsor’s address 705 BRADBURY LANE, P.O. BOX 296, SPARTA, IL, 622860296

Number of participants as of the end of the plan year
Active participants 98

Agent

Name and Address Role Appointment Date
DEBORAH DIANE KELLEY, 705 BRADBURY LN PO BOX 296, SPARTA, 62286, RANDOLPH Agent 2015-05-05

President

Name and Address Role
DEBORAH D KELLEY, 803 HILLCREST DR PO BOX 372, SPARTA 62286 President

Secretary

Name and Address Role
AMY E KELLEY 1112 SYCAMORE LN SPARTA IL 62286 Secretary

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMMON No data Voting Rights 2000 1000000 No data

Awards

Contract Type Award or IDV Flag PIID Start Date Current End Date Potential End Date
DEFINITIVE CONTRACT AWARD FA440724C0005 2024-04-01 2024-09-30 2029-02-28
Unique Award Key CONT_AWD_FA440724C0005_9700_-NONE-_-NONE-
Awarding Agency Department of Defense
Link View Page

Award Amounts
Obligated Amount 390900.00
Current Award Amount 390900.00
Potential Award Amount 3843850.00

Description
Title FY24 ALS AMBULANCE
NAICS Code 621910: AMBULANCE SERVICES
Product and Service Codes V225: TRANSPORTATION/TRAVEL/RELOCATION- TRAVEL/LODGING/RECRUITMENT: AMBULANCE

Recipient Details
Recipient MEDSTAR AMBULANCE, INC.
UEI JJ45XW155KP5
Recipient Address UNITED STATES, 705 BRADBURY LN, SPARTA, RANDOLPH, ILLINOIS, 622862102

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 27 Jan 2025

Sources: Illinois Office of the Secretary of State

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