FEC Form 1 for CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY/CAROLINAS HEALTHCARE SYSTEM EMPLOYEES FED PACForm 1 for CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY/CAROLINAS HEALTHCARE SYSTEM EMPLOYEES FED PAC

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-220857

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

Fax: 7043559682
Email: MaryAnn.Rouse@CarolinasHealthCare.org

2. Date: 06/02/2006

3. FEC Committee ID #: C00423871 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

Charlotte-Mecklenburg Hospital Authority D/B/A Carolinas HealthCare System
Attention: Mary Ann Rouse
PO Box 32861
Charlotte, North Carolina 282322861
Relationship: Connected Org.
Organization Type: Corporation W/O Capital Stock

Carolinas HealthCare System Employees
Attention: Mary Ann Rouse
PO Box 32861
Charlotte, North Carolina 282322861
Relationship: Affiliated State PAC
Organization Type: Corporation W/O Capital Stock

Custodian of Records:

Mary Ann Rouse
PO Box 32861
Charlotte, NC 282322861
Title: Treasurer
Phone # (704) 355-6306

Treasurer:

Mary Ann Rouse
PO Box 32861
Charlotte, North Carolina 282322861
Title: Treasurer
Phone # (704) 355-6306

Designated Agent(s):

Martha Ann Brawley McConnell
PO Box 32861
Charlotte, North Carolina 28232
Title: Assistant Treasurer
Phone # (704) 355-6304

Banks or Depositories

Wachovia Bank
401 S. Tryon Street
Charlotte, North Carolina 28288

Signed: Mary Ann Rouse
Date Signed: 06/02/2006
Official Committee FAX: 7043559682

(End FEC FORM 1)

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