SW4091101_Permit Contact Update_20240611

ROY COOPER
Governor
ELIZABETH S.BISER
Secretary
WILLIAM E.TOBY VINSON,JR NORTH CAROLINA
interim Director Environmental Quality
June 11, 2024
Hospice of the Piedmont
Attn: William T. Cockerham, Chief Executive Officer
1801 Westchester Drive
High Point,NC 27262
Subject: PERMIT INFORMATION UPDATE ACKNOWLEDGEMENT
State Stormwater Management Permit No. SW4091101
Hospice of Randolph
Randolph County
Dear Mr. Cockerham:
The Division of Energy, Mineral and Land Resources hereby acknowledges receipt of the completed
Permit Information Update Form received on June 7, 2024, with your request to:
❑ Change the name of the project.
Change the legal name of the corporation.
® Change the point of contact.
® Change the permittee or POC mailing address.
❑ Other:
The updated information above has been entered into our database and a copy of the Permit Update
form and this letter have been placed into the file. All future correspondence will reference the above
changes. This project will be kept on file at the Winston Salem Regional Office. If you have any questions
concerning this permit,please contact Kaitlin Peck in the Central Office at 919-707-9209 or
[e-mail].
Si cerely,
ox illiam . Toby Vison, Jr.,Interim Director
ivis on of Energy,Mineral and Land Resources
Enclosure: Permit Information Update Form
DES/jf: \\\WaterResources\DEMLR-Stormwater\SW Permits\SW4091101
cc: Winston Salem Regional Office Stormwater File
D E Q North Carolina Department of Environmental Quality I Division of Energy,Mineral and Land Resources
512 North Salisbury Street 1 1612 Mail Service Center I Raleigh,North Carolina 27699-1612
NORTH CAROLMlA _` _'
919.707.9200

UEMLK USE UNLY
Date Received Fee Paid Permit Number
STATE STORMWATER:
PERMIT INFORMATION UPDATE APPLICATION FORM
There is NO FEE for updating project name or permittee information.
This form is to only to be used by the current permittee to notify the Division of.-
1) changes to the Point of Contact(signing official) for the current permittee (LLC, Corporation, FICA or POA);
2) changes to the mailing address, phone number or email address of the current permittee;
3) changes to the name of the project; and
4) changes to the legal corporate name as documented by a Name Change or Merger filed with the NCSOS.
A. NEW PERMIT INFORMATION
State Stormwater Permit Number: SW4091101
Are you updating
(check all that apply): If so, please provide the updated information:
❑ Project name
® Corporation Name' Hospice of the Piedmont
® Permit Contact Name2,3 William T. Cockerham
® Permit Contact Title Chief Executive Officer
® Mailing Address3 1801 Westchester Drive; High Point, NC 27262
® Phone number 336-889-8446
® Email address tcockerham(d,)hospiceofthepiedmont.orq
' Provide documentation such as a Name Change/Merger filed with the NCSOS.
2 Provide supporting documentation such as NCSOS filing. The permit contact's position must be in accordance
with 15A NCAC 02H .1040(1).
3 If more than one point of contact or mailing address is being changed, please attach a separate sheet.
B. CERTIFICATION OF PERMITTEE
I, William T. Cockerham , the current permittee, hereby notify DEMLR that I am making the
changes as listed in Section A above. I further attest that this application for an update to the permit information currently
on file is accurate and complete to the best of my knowledge.
Signature: 90�� Date: J& �/ad��
^ '`- A
�1f I, ww-5 /\. Y�SQ� a Notary Public for the State of Noy_k n tw7S 0-
County of CkWA(d —, do hereby certify that UVi'�IQ.m-T- adl-e �
pe� i� , f�cY�kj�efore me this the "I� day of �U 2� 20 A , and acknowledge the due
e ir�ri�of theYta i_% instrument. Witness my hand and official seal,
j%%ry eal _d U
s Not��y,`$+Ig�`
My commission expires Sit 202.
Stormwater Permit Information Update Form Page 1 of 1 May 11,2017

SOSID: 0071370
Date Filed: 9/30/2019 2:36:00 PM
Elaine F.Marshall
North Carolina Secretary of State
C2019 266 01128
ARTICLES OF MERGER
s
MERGING
l
HOSPICE OF RANDOLPH COUNTY, INC.
A North Carolina Nonprofit Corporation
WITH AND INTO
HOSPICE OF THE PIEDMONT,INC.
A North Carolina Nonprofit Corporation
Pursuant to North Carolina General Statute Section 55A-11-04 of the North Carolina
Nonprofit Corporation Act(the"Act"),the undersigned entity does hereby submit the following
Articles of Merger as the surviving nonprofit corporation in a merger between two or more
nonprofit corporations.The name of the surviving corporation is The Hospice of the Piedmont,
Inc.,a nonprofit corporation organized under the laws of North Carolina.
1. The address of the surviving entity is: 1801 Westchester Drive
High Point,North Carolina 27262.
2. The name of the merging entity is Hospice of Randolph County, Inc., a nonprofit
corporation organized under the laws of North Carolina.
3. The address of the merging entity is 416 Vision Drive
Asheboro,NC 27203.
4. A Plan of Merger has been duly approved in the manner required by law by each of the
nonprofit corporations participating in the merger.
5. There are amendments to the articles of incorporation of the surviving corporation
provided in the Plan of Merger. The articles of incorporation of the surviving corporation shall be
restated as provided in the Restated Articles of Incorporation filed with Articles of Restatement
effective as of the Effective Date of the merger
6. The Articles of Merger shall be effective as of September 30,2019.

i
f
This the r 3 th day of September,2019.
HOSPICE OF THE PIEDMONT,INC.
1
f A North Carolina nonprofit corporation
l
By:
Name:William T. (Trent) Cockerham,President&CEO
2