Articles Of Incorporation Nonprofit Corporation Community Third Party Or Medicaid Pooled Trust {N-15}

BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622 (Revised August 2017) Form N-15 State of North Carolina Department of the Secretary of State ARTICLES OF INCORPORATION NONPROFIT CORPORATION COMMUNITY THIRD PARTY OR MEDICAID POOLED TRUST Pursuant to 24755A-2-02 and 24736D of the General Statutes of North Carolina, the undersigned corporation does hereby submit these Articles of Incorporation for the purpose of forming a Community Third Party or Pooled Trust nonprofit corporation. 1. The name of the corporation is: 2. (Check only if applicable.) The corporation is a charitable or religious corporation as defined in NCGS 24755A-1-40(4). 3. The street address and county of the initial registered office of the corporation is: Number and Street City, State, Zip CodeCounty 4. The mailing address if different from the street address of the initial registered office is: 5. The name of the initial registered agent is: 6. The name, address, and relationship to the Beneficiary of each board member/incorporator is as follows: Name Relationship Business Address 7. (Check either a or b below.) a.The corporation will have members. b.The corporation will not have members. 8. Attached are provisions regarding the settlement of the corporation222s assets upon its dissolution. 9. Any other provisions which the corporation elects to include are attached. 10. The requirements of 24736D-4 have been met. American LegalNet, Inc. www.FormsWorkFlow.com BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622 (Revised August 2017) Form N-15 11.Attached is a copy of the By-laws adopted by the Board in the manner prescribed by law.12.The street address and county of the principal office of the corporation is:Number and Street City, State, Zip CodeCounty 13.The mailing address if different from the street address of the principal office is: 14.These articles will be effective upon filing, unless a later time and/or date is specified: This is theday of ,20. Business Entity Name Signature of Incorporator Type or print Incorporator222s name and title NOTES: 1.Filing fee is $60. This document must be filed with the Secretary of State. American LegalNet, Inc. www.FormsWorkFlow.com