2017 FOREIGN NOT FOR PROFIT CORPORATION ANNUAL REPORT FILED

DOCUMENT# F13000001841 Jan 24, 2017

Entity Name: INDEPENDENT ADOPTION CENTER, INC. Secretary of State
CC5423521479
Current Principal Place of Business:
2300 CLAYTON RD SUITE 1150
CONCORD, CA 94520

Current Mailing Address:

2300 CLAYTON RD SUITE 1150
CONCORD, CA 94520

FEI Number: 94-2867221 Certificate of Status Desired: No

Name and Address of Current Registered Agent:
HODGES, MARCIA
3030 N ROCKY POINT DR W STE 150
TAMPA, FL 33607 US

The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida.

SIGNATURE: MARCIA HODGES 01/24/2017

Electronic Signature of Registered Agent Date

Officer/Director Detail :
Title PRESIDENT Title SECRETARY
Name KUHL, GREG Name ZWERLING, CHRISTINE
Address 533 AIRPORT BLVD. Address 4548 TOYON PL.
SUITE 400
City-State-Zip: OAKLAND CA 94619
City-State-Zip: BURLINGAME CA 94010
Title MEMBER
Title TREASURER
Name REMENTERIA, MELISSA
Name KING, CAMILLE
Address 14132 SW 154 CT
Address 1326 EVERETT ST.
City-State-Zip: MIAMI FL 33196
City-State-Zip: EL CERRITO CA 94530
Title OFFICER
Title OFFICER
Name SPARLING, SUSAN
Name KAPLAN, ALEX
Address 2300 CLAYTON RD SUITE 1150
Address 2300 CLAYTON RD SUITE 1150
City-State-Zip: CONCORD CA 94520
City-State-Zip: CONCORD CA 94520
Title OFFICER
Title OFFICER
Name WARD, DAN
Name WORRELL, NANCY
Address 2300 CLAYTON RD SUITE 1150
Address 2300 CLAYTON RD SUITE 1150
City-State-Zip: CONCORD CA 94520
City-State-Zip: CONCORD CA 94520
Continues on page 2

I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under
oath; that I am an officer or director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 617, Florida Statutes; and that my name appears
above, or on an attachment with all other like empowered.

SIGNATURE: GREG KUHL PRESIDENT 01/24/2017

Electronic Signature of Signing Officer/Director Detail Date
Officer/Director Detail Continued :
Title OFFICER
Name DICKISON, MATTHEW
Address 2300 CLAYTON RD SUITE 1150
City-State-Zip: CONCORD CA 94520