FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-1273574
1. CAROLINA NEUROSURGERY AND SPINE ASSOCIATES P A PAC
225 BALDWIN AVENUECHARLOTTE, NC 28204
Email: mary.cloninger@cnsa.com;mary.cloninger@cnsa.com
NOTE: Email address is different than previously reported
2. Date: 10/16/2018
3. FEC Committee ID #: C00544841 This committee is a separate segregated fund. Its connected organization is a CorporationAffiliated Committees/Organizations
Committee ID# C00544841CAROLINA NEUROSURGERY AND SPINE ASSOCIATES P A PAC
225 BALDWIN AVENUE
CHARLOTTE, North Carolina 28204
Affiliated Relationship Code: Connected Organization
Custodian of Records:
Dr Craig VanDerVeer225 Baldwin Ave
Charlotte, NC 28204
Title: Custodian
Phone # (704) 831-3100
Treasurer:
Dr Craig VanDerVeer225 Baldwin Ave
Charlotte, North Carolina 28204
Title: Treasurer
Phone # (704) 831-3100
Designated Agent(s):
Mary Cloninger225 Baldwin Avenue
Charlotte, North Carolina 28204
Title: Assistant Treasurer
Phone # (704) 831-3100
Banks or Depositories
SunTrust BankPO Box 305183
Nashville, Tennessee 372305183