Exhibit 3.409

PAGE 1

     I, JEFFREY W. BULLOCK, SECRETARY OF STATE OF THE STATE OF DELAWARE, DO HEREBY CERTIFY THE ATTACHED ARE TRUE AND CORRECT COPIES OF ALL DOCUMENTS ON FILE OF “WYTHE COUNTY PHYSICIAN PRACTICES, LLC” AS RECEIVED AND FILED IN THIS OFFICE.

     THE FOLLOWING DOCUMENTS HAVE BEEN CERTIFIED:

     CERTIFICATE OF FORMATION, FILED THE TWENTY-EIGHTH DAY OF JULY, A.D. 2005, AT 1:45 O’CLOCK P.M.

     AND I DO HEREBY FURTHER CERTIFY THAT THE AFORESAID CERTIFICATES ARE THE ONLY CERTIFICATES ON RECORD OF THE AFORESAID LIMITED LIABILITY COMPANY, “WYTHE COUNTY PHYSICIAN PRACTICES, LLC”.

     4007014    8100H

     110293150

You may verify this certificate online
at corp.delaware.gov/authver.shtml      /s/ Jeffrey W. Bullock     
Jeffrey W. Bullock, Secretary of State

AUTHENTICATION:  8620356

                       DATE:  03-14-11

Certificate of Formation
of
Wythe County Physician Practices, LLC

     The undersigned, an authorized natural person, for the purpose of forming a limited liability company, under the provisions and subject to the requirements of the State of Delaware, particularly Chapter 18, Title 6 of the Delaware Code and the acts amendatory thereof and supplemental thereto, and known, identified, and referred to as the Delaware Limited Liability Company Act (the “Act”), hereby certifies that:

     FIRST: The name of the limited liability company is Wythe County Physician Practices, LLC (the “Company”).

     SECOND: The address of the registered office and the name and address of the registered agent of the Company required to be maintained by Section 18-104 of the Act is The Corporation Trust Company, Corporation Trust Center, 1209 Orange Street, Wilmington, Delaware 19801.

     IN WITNESS WHEREOF, the undersigned has executed this Certificate of Formation as of July 27, 2005.

By:	/s/ Mary Kim E. Shipp
	Mary Kim E. Shipp
	Authorized Person

State of Delaware
Secretary of State
Division of Corporations
Delivered 02:25 PM 07/28/2005
FILED 01:45 PM 07/28/2005
SRV 050623539 – 4007014 FILE