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  5. LIFESTAR AMBULANCE SERVICE, INC.

LIFESTAR AMBULANCE SERVICE, INC.

Company Details

Entity Name: LIFESTAR AMBULANCE SERVICE, INC.
Jurisdiction: Illinois
Entity Type: Corporation - Domestic BCA
Status: Goodstanding
Date Formed: 28 Jun 1996
Company Number: CORP_58935565
File Number: 58935565
Type of Business: Business Corporations
Place of Formation: ILLINOIS

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LIFESTAR AMBULANCE SERVICE, INC. 401(K) RETIREMENT PLAN 2023 371359168 2024-03-01 LIFESTAR AMBULANCE SERVICE, INC. 83
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1979-01-01
Business code 621900
Sponsor’s telephone number 8005419180
Plan sponsor’s address PO BOX 1838, CENTRALIA, IL, 62801

Signature of
Role Plan administrator
Date 2024-03-01
Name of individual signing KRISTY CAMPBELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-03-01
Name of individual signing KRISTY CAMPBELL
Valid signature Filed with authorized/valid electronic signature
LIFESTAR AMBULANCE SERVICE, INC. 401(K) RETIREMENT PLAN 2022 371359168 2023-05-03 LIFESTAR AMBULANCE SERVICE, INC. 103
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1979-01-01
Business code 621900
Sponsor’s telephone number 8005419180
Plan sponsor’s mailing address PO BOX 1838, CENTRALIA, IL, 62801
Plan sponsor’s address 940 NORTH ELM STREET, CENTRALIA, IL, 62801

Number of participants as of the end of the plan year
Active participants 68
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 13
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 42
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2023-05-03
Name of individual signing KRISTY CAMPBELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-05-03
Name of individual signing KRISTY CAMPBELL
Valid signature Filed with authorized/valid electronic signature
LIFESTAR AMBULANCE SERVICE, INC. 401(K) RETIREMENT PLAN 2021 371359168 2022-09-06 LIFESTAR AMBULANCE SERVICE, INC. 110
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1979-01-01
Business code 621900
Sponsor’s telephone number 8005419180
Plan sponsor’s mailing address PO BOX 1838, CENTRALIA, IL, 62801
Plan sponsor’s address 940 NORTH ELM STREET, CENTRALIA, IL, 62801

Number of participants as of the end of the plan year
Active participants 76
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 19
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 50
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2022-09-06
Name of individual signing KRISTY CAMPBELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-09-06
Name of individual signing KRISTY CAMPBELL
Valid signature Filed with authorized/valid electronic signature
LIFESTAR AMBULANCE SERVICE, INC. 401(K) RETIREMENT PLAN 2020 371359168 2021-05-10 LIFESTAR AMBULANCE SERVICE, INC. 104
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1979-01-01
Business code 621900
Sponsor’s telephone number 8005419180
Plan sponsor’s mailing address PO BOX 1838, CENTRALIA, IL, 62801
Plan sponsor’s address 940 NORTH ELM STREET, CENTRALIA, IL, 62801

Number of participants as of the end of the plan year
Active participants 83
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 19
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 48
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 1

Signature of
Role Plan administrator
Date 2021-04-30
Name of individual signing KRISTY CAMPBELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-04-30
Name of individual signing KRISTY CAMPBELL
Valid signature Filed with authorized/valid electronic signature
LIFESTAR AMBULANCE SERVICE, INC. 401(K) RETIREMENT PLAN 2019 371359168 2020-04-28 LIFESTAR AMBULANCE SERVICE, INC. 92
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1979-01-01
Business code 621900
Sponsor’s telephone number 8005419180
Plan sponsor’s mailing address PO BOX 1838, CENTRALIA, IL, 62801
Plan sponsor’s address 940 NORTH ELM STREET, CENTRALIA, IL, 62801

Number of participants as of the end of the plan year
Active participants 81
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 17
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 49
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2020-04-28
Name of individual signing KRISTY CAMPBELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-04-28
Name of individual signing KRISTY CAMPBELL
Valid signature Filed with authorized/valid electronic signature
LIFESTAR AMBULANCE SERVICE, INC. 401(K) RETIREMENT PLAN 2018 371359168 2019-03-29 LIFESTAR AMBULANCE SERVICE, INC. 85
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1979-01-01
Business code 621900
Sponsor’s telephone number 8005419180
Plan sponsor’s mailing address PO BOX 1838, CENTRALIA, IL, 62801
Plan sponsor’s address 940 NORTH ELM STREET, CENTRALIA, IL, 62801

Number of participants as of the end of the plan year
Active participants 72
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 13
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 49
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2019-03-29
Name of individual signing KRISTY CAMPBELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-03-29
Name of individual signing KRISTY CAMPBELL
Valid signature Filed with authorized/valid electronic signature
LIFESTAR AMBULANCE SERVICE, INC. 401(K) RETIREMENT PLAN 2017 371359168 2018-08-15 LIFESTAR AMBULANCE SERVICE, INC. 90
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1979-01-01
Business code 621900
Sponsor’s telephone number 8005419180
Plan sponsor’s mailing address PO BOX 1838, CENTRALIA, IL, 62801
Plan sponsor’s address 940 NORTH ELM STREET, CENTRALIA, IL, 62801

Number of participants as of the end of the plan year
Active participants 72
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 12
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 49
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 1

Signature of
Role Plan administrator
Date 2018-08-15
Name of individual signing KRISTY CAMPBELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-08-15
Name of individual signing KRISTY CAMPBELL
Valid signature Filed with authorized/valid electronic signature
LIFESTAR AMBULANCE SERVICE, INC. 401(K) RETIREMENT PLAN 2016 371359168 2017-03-10 LIFESTAR AMBULANCE SERVICE, INC. 98
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1979-01-01
Business code 621900
Sponsor’s telephone number 8005419180
Plan sponsor’s mailing address PO BOX 1838, CENTRALIA, IL, 62801
Plan sponsor’s address 940 NORTH ELM STREET, CENTRALIA, IL, 62801

Number of participants as of the end of the plan year
Active participants 68
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 14
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 55
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2017-03-10
Name of individual signing KRISTY CAMPBELL
Valid signature Filed with authorized/valid electronic signature
LIFESTAR AMBULANCE SERVICE, INC. 401(K) RETIREMENT PLAN 2015 371359168 2016-03-15 LIFESTAR AMBULANCE SERVICE, INC. 105
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1979-01-01
Business code 621900
Sponsor’s telephone number 8005419180
Plan sponsor’s mailing address PO BOX 1838, CENTRALIA, IL, 62801
Plan sponsor’s address 940 NORTH ELM STREET, CENTRALIA, IL, 62801

Number of participants as of the end of the plan year
Active participants 75
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 17
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 64
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2016-03-15
Name of individual signing KRISTY CAMPBELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-03-15
Name of individual signing KRISTY CAMPBELL
Valid signature Filed with authorized/valid electronic signature
LIFESTAR AMBULANCE SERVICE, INC. 401(K) RETIREMENT PLAN 2014 371359168 2015-04-20 LIFESTAR AMBULANCE SERVICE, INC. 110
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1979-01-01
Business code 621900
Sponsor’s telephone number 8005419180
Plan sponsor’s mailing address PO BOX 1838, CENTRALIA, IL, 62801
Plan sponsor’s address 940 NORTH ELM STREET, CENTRALIA, IL, 62801

Number of participants as of the end of the plan year
Active participants 72
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 29
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 73
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2015-04-20
Name of individual signing KRISTY CAMPBELL
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-04-20
Name of individual signing KRISTY CAMPBELL
Valid signature Filed with authorized/valid electronic signature

Agent

Name and Address Role Appointment Date
JOHN A WRIGHT, 940 N ELM, CENTRALIA, 62801, MARION Agent 2024-12-11

President

Name and Address Role
ROGER D CAMPBELL 940 N ELM ST, CENTRALIA 62801 President

Secretary

Name and Address Role
KRISTY CAMPBELL Secretary

Shares

Class Series Voting Rights Authorized Shares Issued Shares Par Value
COMMON No data Voting Rights 1000 1000000 No data

Related by officers

KRISTY CAMPBELL

GRAMS, INC.

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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