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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1006278

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1. CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY/CAROLINAS HEALTHCARE SYSTEM EMPLOYEES FED PAC

    NOTE:Commmittee Name is different than previously reported

    ATTENTION: MARY ANN ROUSE
    1000 BLYTHE BOULEVARD
    CHARLOTTE, NC 282032861

    NOTE: Address is different than previously reported

    Email: MaryAnn.Rouse@CarolinasHealthCare.org

2. Date: 06/02/2006

3. FEC Committee ID #: C00423871 This committee is a separate segregated fund. Its connected organization is a Corporation W/O Capital Stock

Affiliated Committees/Organizations

Charlotte-Mecklenburg Hospital Authority D/B/A Carolinas HealthCare System
Attention: Mary Ann Rouse
PO Box 32861
Charlotte, North Carolina 282322861
Affiliated Relationship Code: Connected Organization

Carolinas HealthCare System Employees
Attention: Mary Ann Rouse
PO Box 32861
Charlotte, North Carolina 282322861
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Mary Ann Rouse
PO Box 32861
Charlotte, NC 28232
Title: Treasurer
Phone # (704) 446-6129

Treasurer:

Mary Ann Rouse
PO Box 32861
Charlotte, North Carolina 28232
Title: Treasurer
Phone # (704) 446-6129

Designated Agent(s):

Martha Ann Brawley McConnell
PO Box 32861
Charlotte, North Carolina 28232
Title: Assistant Treasurer
Phone # (704) 446-3032

Banks or Depositories

Wells Fargo Bank, N.A.
PO Box 63020
San Francisco, California 94163

Signed: Mary Ann Rouse
Date Signed: 05/01/2015

(End FEC FORM 1)

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