NCC213975_Annual Fee Payment Record_20220803

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 6/30/2022 7:42:38 AM (Workflow Start Event)
Submit by Tran, Kieu M 8/3/2022 11:19:23 AM (2022 Annual Fee Payment Verification for NCC213975-2022)
0 Michelle Clements
• Tran, Kieu M assigned the task to Tran, Kieu M 8/3/2022 11:19 AM
• The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: August 11, 2022 5:00 PM
6/30/2022 7:42 AM

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NORTH CAROLINA
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Certificate of NCC213975
Coverage (COC) No. * This is passed from the workflow when the invoice is filed.
NC Reference COC NCG01-2021-3975
No. *
Permit Status: Active
Year COC Issued 2021
This field will be hidden.
Check previous years for outstanding fees (years that do not apply will be blank):
2020 Fee Status
2021 Fee Status
Project Name* CHIC Surgical Department Renovation
Project Address* 3500 Arendell Street, Morehead City, NC
Permittee* Carteret County General Hospital Corporation
County Carteret
Invoice No.* NCC213975-2022
This is passed from the workflow when the invoice is filed.
Annual Fee* $ 100.00
Invoice Date* 7/1/2022
This is passed from the workflow when the invoice is filed.
Invoice Due Date* 8/1/2022
This is passed from the workflow when the invoice is filed.
An automated email reminder is sent to the permittee when the invoice is due. Wait until invoice is 15 days overdue
before proceeding to a Notice of Deficiency.
Days Overdue 2
Wait at least 15 days until proceeding to NOD.
Important: If you change the choice below to Payment NOT RECEIVED, the fee status becomes PAST DUE, and the
permittee will receive a Notice of Deficiency.
Annual Fee Payment • Fee Payment Received or Not Applicable.
Received* Fee Payment NOT RECEIVED.
Date Payment 8/3/2022
Received * Or, if WAIVED or NOT RECEIVED, this is the date that status is recorded.

Method of Payment* electronic
check
other
ePayment 646365592
Transaction Number*
Fee Status* PAID
Legally Responsible Harvey Case
Person (Orig.)
Original Permittee E- [e-mail]
mail *
CONFIRM Permittee [e-mail]
E-mail * Opportunity to modify problem e-mail address or permittee contact info
Original Site Contact [e-mail]
E-mail *
CONFIRM Site [e-mail]
Contact E-mail* Opportunity to correct problem e-mail address or site contact info
Original Billing E-mail [e-mail]
(If available)
CONFIRM Billing E- [e-mail]
mail Opportunity to correct problem e-mail address or billing contact info
Billing Telephone No. 252-499-6094
Permittee Email for
[e-mail]
30-day Reminder
This is the email for the 30-day reminder if needed (passed from workflow).
Site Contact Email for
[e-mail]
30-day Reminder
This is the email for the 30-day reminder if needed (passed from workflow)
Billing Contact Email
[e-mail]
for 30-day Reminder
This is the email for the 30-day reminder if needed (passed from workflow).
Project Name for 30-
CHC Surgical Department Renovation
day Reminder
The project name is passed from workflow for the 30-day reminder
Permittee Name for
Carteret County General Hospital Corporation
30-day Reminder
The permittee is passed from workflow for the 30-day reminder
County for 30-day Carteret
Reminder The county is passed from workflow for the 30-day reminder
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date * 8/3/2022