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State of North Carolina

Department of the Secretary of State

ARTICLES OF INCORPORATION NONPROFIT CORPORATION

COMMUNITY THIRD PARTY OR MEDICAID POOLED TRUST

Pursuant to

55A-2-02 and §36D 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

55A-1-40(4).

3. The street address and county of the initial registered office of the corporation is:

Number and Street_________________________________________________________________________________________

City, State, Zip Code___________________________________________________County______________________________

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: __________________

________________________________________________________________________________________________________

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 corporation’s assets upon its dissolution.

9. Any other provisions which the corporation elects to include are attached.

10. The requirements of §36D-4 have been met.

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:

____________________________________________________________________County_____________________________

13. The mailing address if different from the street address of the principal office is:

______________________________________________________________________________________________________

Revised July 2010

Form N-15

CORPORATIONS DIVISION

P. O. BOX 29622

RALEIGH, NC 27626-0622

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