EX-99.T3A(2)(103) 104 tm2421979d4_ext3a2-103.htm EXHIBIT 99.T3A(2)(103)

 

Exhibit T3A.2.103

 

 

[LOGO] 

Prescribed by J. Kenneth Blackwell

Ohio Secretary of State
Central Ohio: (614) 466-3910
Toll Free: 1-877-SOS-FILE (1-877-767-3453)

www.state.oh.us/sos
e-mail: busserv@sos.state.oh.us

 

 

 

Expedite this Form: (Select One)
Mail Form to one of the Following:
x  Yes PO Box 1390
Columbus, OH, 43216
***Requires an additional fee of $100***
¨  No PO Box 670
Columbus, OH 43216

 

 

 

 

2003 APR 14 PM 12:03 

 

INITIAL ARTICLES OF INCORPORATION
(For Domestic Profit or Non-Profit)
Filing Fee $125.00

 

THE UNDERSIGNED HEREBY STATES THE FOLLOWING:

 

(CHECK ONLY ONE (1) BOX)

 

(1) x Articles of Incorporation
Profit
(2) ¨ Articles of Incorporation
Non-Profit
(3) ¨

Articles of Incorporation Professional

(170-ARP)

(113-ARF) (114-ARN)   Profession                                                        
ORC 1701 ORC 1702   ORC 1785

 

Complete the general information in this section for the box checked above.  
         
Name of Corporation Envision Pharmaceutical Services, Inc.
         
Location Aurora   Portage  
  (City)   (County)  
         
Effective Date 4/15/03 Date specified can be no more than 90 days after date of filing.
  (mm/dd/yyyy)      
         
¨ Check here if additional provisions are attached

 

Complete the information in this section if box (2) or (3) is checked. Completing this section is optional if box (1) is checked.
Purpose for which corporation is formed
  To engage in any lawful act or activity for which corporations may be formed under Section 1701.01 to 1701.98, inclusive,
  of the Ohio Revised Code.  
     
     

 

Complete the information in this section if box (1) or (3) is checked.        
           
The number of shares which the corporation is authorized to have outstanding (Please state if shares are common or preferred and their par value if any)
1,000   Common   No par
  (No. of Shares)   (Type)   (Par Value)
           
(Refer to instructions if needed)          

 

Page 1 of 3

 

 

Completing the information in this section is optional      
             
The following are the names and addresses of the individuals who are to serve as initial Directors.
             
  (Name)          
             
  (Street)   NOTE: P.O. Box Addresses are NOT acceptable.  
             
  (City)   (State)   (Zip Code)  
             
  (Name)          
             
  (Street)   NOTE: P.O. Box Addresses are NOT acceptable.  
             
  (City)   (State)   (Zip Code)  
             
  (Name)          
             
  (Street)   NOTE: P.O. Box Addresses are NOT acceptable.  
             
  (City)   (State)   (Zip Code)  
             

 

REQUIRED        

 Must be authenticated

(signed) by an authorized

/s/ Ronald B. Salupo  

4/11/03

 
representative Authorized Representative   Date  
(See Instructions)        
         
  Ronald B. Salupo      
  Print Name      
         
         
  Authorized Representative   Date  
         
         
  Print Name      
         
         
  Authorized Representative   Date  
         
         
  Print Name      

 

Page 2 of 3

 

 

Complete the information in this section if box (1) (2) or (3) is checked.  
 
ORIGINAL APPOINTMENT OF STATUTORY AGENT
 
The undersigned, being at least a majority of the incorporators of Envision Pharmaceutical Services, Inc. hereby appoint the following to be statutory agent upon whom any process, notice or demand required or permitted by statute to be served upon the corporation may be served. The complete address of the agent is
         
  Ronald B. Salupo  
  (Name)  
  75 Barrington Town Square Drive, Unit 52  
  (Street) NOTE: P.O. Box Addresses are NOT acceptable.
       

  Aurora , Ohio 44202  
  (City)   (Zip Code)
       

Must be authenticated by an authorized representative   /s/ Ronald B. Salupo   4/11/03
    Authorized Representative   Date
         
         
    Authorized Representative   Date
         
         
    Authorized Representative   Date
         

ACCEPTANCE OF APPOINTMENT
     
The Undersigned, Ronald B. Salupo , named herein as the
Statutory agent for, Envision Pharmaceutical Services, Inc.
, hereby acknowledges and accepts the appointment of statutory agent for said entity.
   
  Signature: /s/ Ronald B. Salupo  
    (Statutory Agent)  

 

Page 3 of 3

 

 

UNITED STATES OF AMERICA,
STATE OF OHIO,
OFFICE OF SECRETARY OF STATE

 

I, Jon Husted, Secretary of State of the State of Ohio, do hereby certify that the paper to which this is attached is a true and correct copy from the original record now in my official custody as Secretary of State.

 

[LOGO]

 

Witness my hand and the seal of the Secretary of State at Columbus, Ohio this 26th day of November, A.D. 2018.

 

Ohio Secretary of State

 

/s/ Jon Husted

 

 

Validation Number:
201833004058

  

 

 

 

 

 

 

DATE:
10/29/2013

DOCUMENT ID
201330200361

DESCRIPTION
CONVERSION WITHIN SOS RECORDS (CVS)

FILING
125.00

EXPED
300.00

PENALTY

CERT
.00

COPY
.00

 

Receipt
This is not a bill. Please do not remit payment.

 

BAKER & HOSTETLER LLP
ATTN: SONIA K. LOWE, PARALEGAL
65 E. STATE STREET, SUITE 2100
COLUMBUS, OH 43215

 

 

STATE OF OHIO
CERTIFICATE

 

Ohio Secretary of State, Jon Husted

1381411

 

It is hereby certified that the Secretary of State of Ohio has custody of the business records for

 

ENVISION PHARMACEUTICAL SERVICES, LLC

 

and, that said business records show the filing and recording of:

 

Document(s)  Document No(s):
CONVERSION WITHIN SOS RECORDS 201330200361

 

Effective Date: 11/04/2013

 

CHANGE BUSINESS TYPE DOM. PROFIT LIM. LIAB. CO.

 

 

 

 

 

 

 

 

[SEAL]

 

United States of America
State of Ohio
Office of the Secretary of State

Witness my hand and the seal of the Secretary of State at Columbus, Ohio this 29th day of October, A.D. 2013.

 

/s/ Jon Husted

 

Ohio Secretary of State

 

 

 

 

 

 

 

 

 

 

 

[LOGO]

Form 700 Prescribed by:

JON HUSTED

Ohio Secretary of State

 

Central Ohio: (614) 466-3910
Toll Free: (877) SOS-FILE (767-3453)
www.OhioSecretaryofState.gov

Busserv@OhioSecretaryofState.gov

 

Makes checks payable to Ohio Secretary of State

 

Mail this form to one of the following:

Regular Filing (non expedite)
P.O. Box 1329
Columbus, OH 43216

 

Expedite Filing (Two-business day processing
time requires an additional $100.00).
P.O. Box 1390
Columbus, OH 43216

 

 

Certificate for Conversion for Entities Converting
Within or Off the Records of the Ohio Secretary of State
Filing Fee: $125

 

(CHECK ONLY ONE (1) BOX)

 

(1) x  

Converting Within The Records of the Ohio Secretary of State

 

 

(2) ¨  

Converting Off The Records of the Ohio Secretary of State

 

(187-VXX)  

 

 

Name of the converting entity   Envision Pharmaceutical Services, Inc.
       
Jurisdiction of Formation   Ohio  
       
Charter/Registration Number   1381411  

 

The converting entity is a:
(Check Only (1) One Box)

 

x Domestic Corporation (For-Profit or Nonprofit) ¨ Partnership
       
¨ Foreign Corporation (For-Profit or Nonprofit) ¨ Domestic Limited Partnership
       
¨ Domestic Nonprofit Limited Liability Company ¨ Foreign Limited Partnership
       
¨ Foreign Nonprofit Limited Liability Company ¨ Domestic Limited Liability Partnership
       
¨ Domestic For-Profit Limited Liability Company ¨ Foreign Limited Liability Partnership
       
¨ Foreign For-Profit Limited Liability Company    

 

The converting entity hereby states that it has complied with all laws in the jurisdiction under which it exists and that those laws permit the conversion.

 

 

Form 700Page 1 of 5 

 

 

 

Name of the converted entity   Envision Pharmaceutical Services, LLC
     
Jurisdiction of Formation   Ohio  

 

The converted entity is a:
(Check Only (1) One Box)

 

¨ Domestic Corporation (For-Profit) ¨ Partnership
       
¨ Foreign Corporation (For-Profit or Nonprofit) ¨ Domestic Limited Partnership
       
¨ Domestic Nonprofit Limited Liability Company ¨ Foreign Limited Partnership
       
¨ Foreign Nonprofit Limited Liability Company ¨ Domestic Limited Liability Partnership
       
x Domestic For-Profit Limited Liability Company ¨ Foreign Limited Liability Partnership
       
¨ Foreign For-Profit Limited Liability Company    

 

 

 

Effective Date 11/04/2013  (The conversion is effective upon the filing of this certificate or on a later date specified in the certificate)
(Optional)

 

Name and address of the person or entity that will provide a copy of the declaration of conversion upon written request.

 

Kimberly S. Kirkbride
Name
 
2181 E. Aurora Road
Mailing Address

 

Twinsburg   Ohio   44087
City   State   Zip Code

 

 

Required Information that must accompany conversion certificate if box 2 is checked  

 

If the converting entity is a domestic or foreign entity that will not be licensed in Ohio, provide the name and address of the statutory agent upon whom any process, notice or demand may be served.

 

 
Name of Statutory Agent
 
 
Mailing Address

 

    Ohio    
City   State   Zip Code

 

¨  If the agent is an individual using a P.O. Box, check this box to confirm that the agent is an Ohio resident.

 

 

See instructions for additional filing requirements if
  (1)   the conversion creates a new domestic entity,
  (2)   the converted entity is a foreign entity that desires to transact business in Ohio; or
  (3)   if a domestic corporation or foreign corporation licensed in Ohio is the converting entity.
   

 

Form 700Page 2 of 5 

 

 

IN WITNESS WHEREOF, the conversion is authorized on behalf of the converting entity and that each person signing the certificate of conversion is authorized to do so.

 

Required    
Must be signed by an /s/ Kimberly S. Kirkbride  
authorized representative. Signature  
     
     
  By (if applicable)  
     
  Kimberly S. Kirkbride  
  Print Name  
     
     
     
  Signature  
     
     
  By (if applicable)  
     
     
  Print Name  
     
     
     
  Signature  
     
     
  By (if applicable)  
     
     
  Print Name  

 

Form 700Page 3 of 5 

 

 

Complete the information in this section.

 

AFFIDAVIT

 

In lieu of dissolution releases from various governmental authorities.

  Envision Pharmaceutical Services, Inc.  

Name of Corporation

 

The undersigned, being first duly sworn, declares that on the dates indicated below, each of the named state governmental agencies was advised IN WRITING of the scheduled date of filing of the Certificate and was advised IN WRITING of the acknowledgement by the corporation of the applicability of the provisions of section 1701.95 of the ORC.

 

Agency Date Notified   Agency Date Notified
         
Ohio Bureau of Workers' 10/17/2013   Ohio Job & Family Services 10/17/2013  
Compensation   Status and Liability Section
30 W. Spring Street   Data Correspondence Control
Columbus, Ohio 43215   Fax: 614-752-4811
      Phone: 614-466-2319  
*Only required for domestic for-profit corporations   Overnight: Regular:
      P.O. Box 182413 P.O. Box 182413
      Columbus, OH 43218-2413 Columbus, OH 43218-2413
         
Agency Date Notified  

 

 

x   The corporation is not required to pay or the department of taxation has not assessed any personal property tax.

 

Ohio Department of Taxation 10/17/2013  
Taxpayer Services Division/Tax Release Unit  
PO Box 182382  
Columbus, OH 43218-2382  
Dissolution@tax.state.oh.us  
*Complete this date notified field only if the corporation is a domestic non-profit corporation or foreign corporation.  

[see* note below]

 

 

*Note: Domestic for-profit corporations must submit with this filing a Certificate of Tax Clearance issued by the Ohio Department of Taxation.

 

Note: This affidavit must be signed by one or more persons executing the certificate or by an officer of the corporation.

 

Signature /s/ Kimberly S. Kirkbride   Title Treasurer  

 

Kimberly S. Kirkbride
Name
 
2181 E. Aurora Road
Mailing Address

 

Twinsburg   Ohio   44087
City   State   Zip Code

 

Acknowledged before me and subscribed in my presence on 10/28/2013  
  Date

 

 

 

[SEAL]  

 

 

         
         
         
  Theresa L. Moutz   Commission Expires 10/31/2017
  Notary Public      
  /s/ Theresa L. Moutz     Date
         

 

Form 700Page 4 of 5 

 

 

AFFIDAVIT OF PERSONAL PROPERTY

 

State of Ohio  

 

County of Summit  

 
Kimberly S. Kirkbride    
Name of Officer

 

Treasurer of Envision Pharmaceutical Services, Inc.
Title of Officer   Name of Corporation

 
and that this affidavit is made in compliance with Section  1701.86(H)(1)  of the Ohio Revised Code.

 

That above-named corporation: (Check one (1) of the following)

 

¨Has no personal property in any county in Ohio

¨Is the type required to pay personal property taxes to state authorities only

xHas personal property in the following county (les)

 

Summit County      

 

Signature: /s/ Kimberly S. Kirkbride   Title: Treasurer  

 
Acknowledged before me and subscribed in my presence on Date 10/28/2013  
 
Seal    

 

  Theresa L. Moutz
  Notary Public
  /s/ Theresa L. Moutz

 
Expiration date of Notary Public's Commission Date 10/31/2017  

 

[SEAL] 

 

Form 700Page 5 of 5 

 

 

[LOGO] Department of Taxation

Taxpayer Services Division
P.O. Box 182382
Columbus, Ohio 43218-2382
Phone: 888-405-4039
TTY/TDD: 800-750-0750
http://tax.ohio.gov

 

Date: October 17, 2013

 

Sonia K. Lowe
65 East State Street
Suite 2100
Columbus, OH 43215
USA

 

Re: Certificate of Tax Clearance (D2)
  ENVISION PHARMACEUTICAL SERVICES INC

 

Dear Taxpayer:

 

Enclosed is your requested Certificate of Tax Clearance. This certificate, when timely presented to the Ohio Secretary of State, will provide the necessary guarantee that all taxes administered by the tax commissioner that are required to be filed and paid to the Ohio Department of Taxation (Department) have been satisfied up to the issue date indicated on the certificate. This certificate does not preclude the Department from issuing a bill and/or assessment against the entity for any tax returns and tax liabilities that become due after the certificate issue date or as a result of an examination or audit for any period ending prior to the date of dissolution with the Ohio Secretary of State.

 

Additionally, to the extent the entity listed below is a member of a commercial activity tax combined or consolidated elected group for any portion of a tax period for which the CAT return and payment are not yet due, the entity remains responsible for supplying its taxable gross receipts to the primary filer prior to the due date of the CAT return and such taxable gross receipts must be included by the primary filer when filing their CAT return for this period.

 

The Certificate of Tax Clearance is valid for 30 days from the date of issuance as indicated on the enclosed certificate and must be filed along with all forms prescribed by the Ohio Secretary of State.

 

Tax Release Unit
P.O. Box 182382
Columbus, OH 43218-2382
Phone: 888-405-4039
Facsimile: 206-984-0378

 

Enclosure

 

 

 

 

[LOGO]

Form 533A Prescribed by:
Ohio Secretary of State

JON HUSTED
Ohio Secretary of State

 

Central Ohio: (614) 466-3910
Toll Free: (877) SOS-FILE (767-3453)
www.OhioSecretaryofState.gov
Busserv@OhioSecretaryofState.gov

 

Mail this form to one of the following:

 

Regular Filing (non expedite)
P.O. Box 670
Columbus, OH 43216

 

Expedite Filing (Two-business day processing
time requires an additional $100.00
).
P.O. Box 1390
Columbus, OH 43216

 

 

Articles of Organization for a Domestic

Limited Liability Company

Filing Fee: $125

 

CHECK ONLY ONE (1) BOX

 

(1) x  

Articles of Organization for Domestic For-Profit Limited Liability Company

(115-LCA)

 

 

(2) ¨  

Articles of Organization for Domestic Nonprofit Limited Liability Company

(115-LCA)

 

 

Name of Limited Liability Company Envision Pharmaceutical Services, LLC  

 

Name must include one of the following words or abbreviations: “limited liability company,” “limited,” “LLC,” “L.L.C.,” “ltd.,” or “ltd”

 

Effective Date 11/04/2013   (The legal existence of the limited liability company begins upon the filing of the articles or on a later date specified that is not more than ninety days after filing)
(Optional) mm/dd/yyyy  
     

 
This limited liability company shall exist for    
(Optional) Period of Existence  

 

Purpose
(Optional)
   
   
   
   
   
   
   
   

 

**Note for Nonprofit LLCs

The Secretary of State does not grant tax exempt status. Filing with our office is not sufficient to obtain state or federal tax exemptions. Contact the Ohio Department of Taxation and the Internal Revenue Service to ensure that the nonprofit limited liability company secures the proper state and federal tax exemptions. These agencies may require that a purpose clause be provided.

 

 

Form 533APage 1 of 3 

 

 

 

ORIGINAL APPOINTMENT OF AGENT

 

The undersigned authorized member(s), manager(s) or representative(s) of

 
Envision Pharmaceutical Services, LLC
Name of Limited Liability Company

 

hereby appoint the following to be Statutory Agent upon whom any process, notice or demand required or permitted by statute to be served upon the limited liability company may be served. The name and address of the agent is

 

Kimberly S. Kirkbride
Name of Agent
 
2181 E. Aurora Road
Mailing Address

 

Twinsburg   Ohio   44087
City   State   ZIP Code

 

ACCEPTANCE OF APPOINTMENT

 
The undersigned, Kimberly S. Kirkbride named herein as the statutory agent
Statutory Agent Name  

 

for Envision Pharmaceutical Services, LLC  
Name of Limited Liability Company  

 

hereby acknowledges and accepts the appointment of agent for said limited liability company

 
Statutory Agent Signature /s/ Kimberly S. Kirkbride  
  Individual Agent's Signature/Signature on Behalf of Corporate Agent  

 

¨           If the agent is an individual and using a P.O. Box, check this box to confirm that the agent is an Ohio resident.

 

 

Form 533APage 2 of 3 

 

 

By signing and submitting this form to the Ohio Secretary of State, the undersigned hereby certifies that he or she has the requisite authority to execute this document.

 

Required    
     
Articles and original appointment of /s/ Kimberly S. Kirkbride  
agent must be signed by a member, Signature  
manager or other representative.    
     
If authorized representative is an By (if applicable)  
individual, then they must sign in    
the “signature” box and print their Kimberly S. Kirkbride  
name in the “Print Name” box. Print Name  
     
If authorized representative is a their    
business entity, not an individual,    
then please print the business name Signature  
in the “signature” box, an authorized    
representative of the business entity    
must sign in the “By” box and print By (if applicable)  
name in the “Print Name” box.    
     
  Print Name  
     
     
     
  Signature  
     
     
  By (if applicable)  
     
     
  Print Name  

 

Form 533APage 3 of 3