EX-3.103 104 g27448exv3w103.htm EX-3.103 exv3w103
EXHIBIT 3.103
United States of America
The State or Washington
Secretary of State
     I, SAM REED, Secretary of. State of the State of Washington and custodian of its seal, hereby issue this
CERTIFICATE OF FORMATION
to
WESTERN WASHINGTON HEALTHCARE, LLC
     a/an WA Limited Liability Company. Charter documents are effective on the date indicated below.
Date: 6/18/2004
UBI Number: 602-405-282
APPID: 110245
     [SEAL]
     Given under my hand and the Seal of the State of Washington at Olympia, the State Capital
         
     
  /s/ Sam Reed    
  Sam Reed, Secretary of State   
     

 


 

         
     
State of Washington
  APPLICATION TO FORM
Secretary of State
  A LIMITED LIABILITY COMPANY
    Please PRINT or TYPE in black ink
  (Per Chapter 25.15 RCW)
 
   
    Sign, date and return original AND ONE COPY to:
  FEE: $175
      CORPORATIONS DIVISION
   
      801 CAPITOL WAY SOUTH — PO Box ___
  EXPEDITED (24-HOUR) SERVICE AVAILABLE - $20 PER ENTITY
      OLYMPIA, WA 98504-0234
  INCLUDE FEE AND WRITE “EXPEDITE” IN BOLD LETTERS
ON OUTSIDE OF ENVELOPE
 
   
     BE SURE TO INCLUDE FILING FEE. Check should be made payable to “Secretary of State”
   
 
  FOR OFFICE USE ONLY
 
  Filed: ___/___/____ ___ 602405282
 
  CORPORATION NUMBER:
Important Person to contact about this filing
            Daytime Phone Number (with area code)
CERTIFICATE OF FORMATION
NAME OF LIMITED LIABILITY COMPANY (LLC) (Must contain the word “Limited Liability Company” “Limited Liability Co.” “L. L. C”- or “LLC’)
     Western Washington Healthcare, LLC
ADDRESS OF LLC’S PRINCIPAL PLACE OF BUSINESS
Street Address (Required) One Park Plaza                      city Nashville                     State TN                     ZIP 37203
PO Box (Optional — Must be in same city as street address _______________ ZIP (If different than street ZIP) ________________
EFFECTIVE DATE OF LLC (Specified effective date may be up to 90 days AFTER receipt of the document by the Secretary of State)
     
o Specific Date:                                         
  þ Upon filing by the Secretary of State
 
   
DATE OF DISSOLUTION (If applicable)
            MANAGEMENT OF LLC IS VESTED IN ONE OR MORE MANAGERS
 
            þYes o No
>>>>PLEASE ATTACH ANY OTHER PROVISIONS THE LLC ELECTS TO INCLUDE<<<<
NAME AND ADDRESS OF WASHINGTON STATE REGISTERED AGENT
Name C T Corporation System
Street Address (Required) 520 Pike Street                      City Seattle,                     State WA                      ZIP 98101
PO Box (Optional — Must be in same city as street address) __________________ ZIP (If different than street ZIP)____________
I consent to serve as Registered Agent in the State of Washington for the above named LLC. I understand it will be my responsibility to accept Service of Process on behalf of the LLC; to forward mail to the LLC; and to immediately notify the Office of the Secretary of State if I resign or change the Registered Office Address.
         
/s/ Mary R. Adams
  Mary R. Adams, Assistant Secretary   06/17/2004
 
Signature of Agent
  Printed Name   Date
NAMES ADDRESSES OF EACH PERSON EXECUTING THIS CERTIFICATE (If necessary, attach additional names and addresses)

         
Printed Name
  Dora A. Blackwood    
 
 
 
   
Address
  One Park Plaza
 
   
Printed Name
       
Address
 
 
   
Printed Name
 
 
   
Address
 
 
   
 
 
 
   
     
Signature
  /s/ Dora A. Blackwood
 
   
City Nashville                     State TN                     ZIP 37203
Signature
   
 
   
City ______________     State ________     Zip_________
Signature
   
City ______________     State ________     Zip_________


 


 

INFORMATION AND ASSISTANCE — 360/753-7115 (TDD — 360/753 — 1485)
Filed
Secretary of State
June 18, 2004
State of Washington