SW3191205_Wellspring Carolina, LLC - Report_1/9/2020

=..: LIMITED LIABILITY COMPANY ANNUAL REPORT
10/2017 Y
NAME OF LIMITED LIABILITY COMPANY: WELLSPRING CAROLINA INVESTMENTS, LLC
SECRETARY OF STATE ID NUMBER: 1080574 STATE OF FORMATION: NC
REPORT FOR THE CALENDAR YEAR: 2019
SECTION A: REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: Hinson, Wesley S.
2. SIGNATURE OF THE NEW REGISTERED AGENT:
3. REGISTERED OFFICE STREET ADDRESS & COUNTY
309 Post Office Drive
Indian Trail, NC 28079-7671 Union Coun
SECTION B: PRINCIPAL OFFICE INFORMATION
E - Filed Annual Report
1080574
CA201908605736
3/27/2019 12:06
❑ Changes
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
4. REGISTERED OFFICE MAILING ADDRESS
309 Post Office Drive
Indian Trail, NC 28079-7671
1. DESCRIPTION OF NATURE OF BUSINESS: Purchase, Manage, Improve, Own & Sell Real Property
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS & COUNTY 5. PRINCIPAL OFFICE MAILING ADDRESS
2133 Garden View Lane 2133 Garden View Lane
Matthews, NC 28104-8062 Matthews, NC 28104-8062
6. Select one of the following if applicable. (Optional see instructions)
❑ The company is a veteran -owned small business
❑ The company is a service -disabled veteran -owned small business
SECTION C: COMPANY OFFICIALS (Enter additional company officials in Section E.)
NAME: Mark W. Boyce
TITLE: Manager
ADDRESS:
2133 Garden View Lane
Matthews, NC 28104
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity.
Mark W. Boyce
SIGNATURE
Form must be signed by a Company Official listed under Section C of This form.
3/27/2019
DATE
Mark W. Boyce Manager
Print or Type Name of Company Official Print or Type Title of Company Official
This Annual Report has been filed electronically.
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626-0525