Fill and Sign the Contact Kansas Secretary of State Kansasgov Form

o Filing fee The filing fee for this document is $90 . o Payment Please enclose a check or money order payable to the Secretary of State. Articles received without the appropriate fee will not be accepted for filing. Please do not send cash. NOTICE : There is a $25 service fee for all checks returned by your financial institution. Also, to expedite processing, please do not use staples on your documents or to a\ ttach checks. o Original certificiate from the regulatory board The certificate must be issued by the State regulatory board for each incorporator stating that they are licensed and that the business entity name is approved. o Corporation name A word of incorporation must be included in the name per K.S.A. 17-2711. Permitted words of incorporation are “P.A.”, “Professional Association”, or “Chartered”. “P.C.” and “Chtd.” are not permitted. Kansas Statutes can be reviewed at www.kslegislature.org . o Resident agent The resident agent is a person or entity that is authorized to accept service of process (lawsuits) on behalf of the business entity. This does not necessarily mean that the agent himself/herself is being sued, but that he/she has the authority and responsibility to accept service of process on behalf of the business. o Registered office The registered office is the address where the resident agent is located. o Mailing address The mailing address is where you would like to receive official mail from the Secretary of State’s Office. o Purpose Must include a specific professional purpose (ex. Practice or Medicine). o Stock You must have at least one share of stock. Number of shares can only be a numerical value. o Incorporators An incorporator can be either an individual or a business. This person or entity is responsible for the formation of the business created by this filing. The incorporator is not necessarily the owner and his/her role in the business may cease as soon as the filing is made. o Directors The directors section (Question 8) must be completed if the incorporator’s power terminates once the document is filed. o Signatures The signature(s) of the incorporator(s) must match those of the licensee(s) as listed on the certificate from the State regulatory board. k a n s a s s e c r e ta ry o f s tat e Professional Association Articles of Incorporation Instructions Kansas Office of the Secretary of State: Memorial Hall, 1st Floor (785) 296-4564 120 S.W. 10th Avenue kssos@sos.ks.gov Topeka, KS 66612-1594 www.sos.ks.gov D PA 51-04 Inst. K.S.A. 17-2709, 17-6002Rev. 04/29/15 tc Please proceed to form. All information on the articles of incorporation must be complete and accompanied by the correct filing fee or the document will not be accepted for filing. Stay up-to-date on your organization’s status, annual report due date and contact addresses by going to www.sos.ks.gov . Instructions: All information must be completed or this document will not be accepted for filing. 1. Name of corporation 2. Name of resident agent and address of registered office in Kansas Must be a Kansas street address. A P.O. Box is unacceptable. Name Street Address City State KS Zip 3. Mailing address Address will be used to send official mail from the Secretary of State’s Office. Attention Name Address City State Zip Country 4. Tax closing month 5. State the professional purpose 6. Total number of shares corporation is authorized to issue Shares Stock Class Par Value /ea. Shares Stock Class Par Value /ea. Shares Stock Class Without Nominal or Par Value Shares Stock Class Without Nominal or Par Value If applicable, state any designations, powers, rights, limitations, or restrictions applicable to any class or any special grant of authority to be given to the board of directors. THIS SPACE FOR OFFICE USE ONLY. 1 / 2 K.S.A. 17-2709, 17-6002Rev. 04/29/15 tc Please continue to next page. k a n s a s s e c r e ta ry o f s tat e Professional Association Articles of Incorporation Kansas Office of the Secretary of State: Memorial Hall, 1st Floor (785) 296-4564 120 S.W. 10th Avenue kssos@sos.ks.gov Topeka, KS 66612-1594 www.sos.ks.gov D PA 51-04 7. Name and mailing address of each incorporator Do not leave blank. If additional space is needed, please provide attachment. Name Address City State Zip Country Name Address City State Zip Country Name Address City State Zip Country 8. Name and mailing address of each member of board of directors This must be completed if incorporator’s power terminates once document is filed. If additional space is needed, please provide attachment. Name Address City State Zip Country Name Address City State Zip Country Name Address City State Zip Country 9. Duration of corporation o Perpetual o Date corporation will cease: Month Day Year 10. Effective date Must be within 90 days of filing. o Upon filing o Future effective date: Month Day Year 11. I/We declare under penalty of perjury pursuant to the laws of the state of \ Kansas that the foregoing is true and correct, and that I/we have remitted the required fee. Signatures must correspond exactly to names of incorporators listed in number 7. Signature of Incorporator Month Day Year Signature of Incorporator Month Day Year Signature of Incorporator Month Day Year 2 / 2 K.S.A. 17-2709, 17-6002Rev. 04/29/15 tc Please review to ensure completion.