NC0060224_Owner name Change_20071211

O�0F W A TF, Michael F.Easley,Governor
William G.Ross Jr.,Secretary
North Carolina Department of Environment and Natural Resources
Q Coleen H.Sullins.Director
Division of Water Quality
December 11,2007
GEORGE W WARE
HIGH COUNTRY HOME CARE INC
PO BOX 658
NEWLAND NC 28657
Subject:NPDES Permit Modification-Ownership Change
Jonas Ridge Adult Care Facility
Formerly Jonas Ridge Nursing/Rest Home
Certificate of Coverage NCO060224
Burke County
Dear Mr.Ware:
Division personnel have reviewed and approved your request for name/ownership change of the subject
certificate of coverage received on November 30,2007. This permit modification documents the change of
ownership of the above reference facility.
Please find enclosed the revised certificate of coverage. All other terms and conditions contained in the original
certificate remain unchanged and in full effect. This modification is issued under the requirements of North Carolina
General Statutes 143-215.1 and the Memorandum of Agreement between North Carolina and the U.S.Environmental
Protection Agency.
If you have any questions concerning this permit modification,please contact the Point Source Branch at (919)
733-5083,extension 350.
Sincerely,
?aurie Singleton
NPDES Point Source Branch
cc: Central Files
Asheville Regional Office,Surface Water Protection
NPDES Unit File NCO060224
N"o�nCarolina
atura!!y
North Carolina Division of Water Quality 1617 Mail Service Center Raleigh,NC 27699-1617 Phone[phone] Customer Service
Internet: h2o.enr.state.nc.us 512 N.Salisbury St. Raleigh,NC 27604 FAX [phone] 1-877-623-6748
An Equal Opportunity/Affirmative Action Employer—50%Recycled/10%Post Consumer Paper

10-18-' 07 10: 16 FROM- T-640 P002/003 F-350
YIArd R Michael F.Easley,Governor
a G William G.Ross Jr.,Secretary
r North Carolina Dcpartmont of Environment and Natural Resources
D Alan W.Klimek,P.E.Director
Division of Water Quality
SURFACE WATER PROTECTION SECTION
PERMIT NAME/OWNERSHIP CHANGE FORM
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N CI N I C I G
II. Permit status prior to status change.
a. Permit issued to (compan tome): D nU S ��I I e 5� 0 M e
b. ,N on legally responsihLL1or permit: J 0 r� i
First MMl f Last
3 Title
II N +rl O O x �) 9
,-- Permit Holder Mailing Address
�11iF u!q^ R n .d,i i V t tt�J lam'�lil� l l l 1
;. _..._._.. City State Zip
( SaR) -733 - a1),q
Phor T
r7c. Facility name(discharge): e� �A,
d, Facility address: 9 D 51 A-u) s i
i�c5 �U
City state Zip �}
e. Facility contact person: R. Bat,Imo;eg-
First / MI Last Phone
III. Please provide the following for the equested change(revised permit).
a. Request for change is a result of. Gl Change in ownership of the facility
❑ Name change of the facility or owner
!f other please explain.-
b. Permit issued to(company name): �A 1 r ie
c. Person legally responsible for permit: Q 'W.
First / hfl / [sst
F Title
Pennit Holder Mailing Address 71
City State Zip
Phone E-mail Address
d. Facility name (discharge): 14; p r lei
e. Facility address:
Ad ress
City State Zip
f. FaciIity contact person: C7 U �e
J first / MI / Last
(Qd) 3V- I952 mks4e �noloGle��un nt�.Corv�
Phone E-mail Address
Revised 712005

10-18 07 10:16 FROM- 1'006/006 r-snld
PERMIT NAM1EIOWNERSHIP CHANGE)=OR.M
Page 2 of 2
TV. Permit contact information: (if different from the person legally responsible for the permit)
Permit contact: Sarr Z
First / Ml / Last
Title
Mailing Address
City state zip
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior to
this ownership or name change?
Yes
❑ No(please explain)
VI. Required Items: THIS APPLICATI0N WILL BE RETURNED UNPROCESSED IF ITEMS ARE
PVCOMPLr E'TE OR MISSING:
❑ This completed application is required for both name change and/or ownership change requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed, or a bill
of sale) is required for an ownership change request. Articles of incorporation are not sufficient for
an ownership change.
•.•.••..•.••.•••.•.............••.•••..•••.•.•e•.•.•••••••••••••••••••••••••••••••••••••••••.•••••••.•r
The certifications below must be completed and signed by both the permit holder prior to the change, and the new
applicant in the case of an ownership change request. For a name change request,the signed Applicant's Certification
is sufficient.
PERMITTER CERTIFICATION(Permit holder prior to ownership change):
1, m k r%r%,.4 R�I`p;P_r , attest that this application for a name/ownership
change has been mewed and is accurate and complete to the best of my knowledge. I understand that if all required
parts of this application are not completed and that if all required supporting information is not included, this
application package will be re d as incomplete.
Signature Dq e
APPLICANT CERTIFICATION:
1, G Cn c e 1 l- L d r P attest that this application for a name/ownership
change has been eviewed and is accurate and complete to the best of my knowledge. I understand that if all required
parts of s application are not completed and that if all required supporting information is not included, this
applicat package will be returned as inc replete.
1) - al, - oy
Signature bate
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface'Water Protection Section
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
Revised 7/2005

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O 3 0 2007 €
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October 16, 2007 OENR• w�tFR ouAt►iy
?OIPtr S')")
RCENCH
Adult Care Liscensure Section
Division of Facility Services
2708 Mill Service Center
Raleigh, NC 27699-2708
Re: Jonas Ridge Rest Home, Inc.
Dear Sir or Madam:
Johnny R.Barrier,President and Bette H.Barrier, Secretary of Jonas Ridge Rest Home,Inc
and hereby certify that as of October 16, 2007, Jonas Ridge Rest Home, Inc. has relinquished
ownership of the facility known as Jonas Ridge Rest Home,Inc. Ownership of the facility was by
High Country Home Care,Inc.,a North Carolina Corporation with a mailing address of PO Box 65 8,
Newland,NC 28657.
Sincerely,
Jonas Ridge Rest Home, Inc.
By:
Johnny i713arrier, President
Attest: X4"';'
Bette . Barrier, Secretary

OMB NO.2502-0265
A B. TYPE OF LOAN:
U.S.DEPARTMENT OF HOUSING&URBAN DEVELOPMENT 1.❑FHA 2.QFmHA 3.QX CONY. UNINS. 4.[]VA 5.QCONV. INS.
6. FILE NUMBER: 7 LOAN NUMBER:
SETTLEMENT STATEMENT 2
8. MORTGAGE INS CASE NUMBER:
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked"[POC]"were paid outside the closing;they are shown here for informational purposes and are not included in the totals.
1.0 3/98 (JONAS RIDGE PROPERTIES.PFD/J0263-R31/11)
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
Jonas Ridge Properties,LLC Johnny R. Barrier and wife, High Country Bank,
9051 Hwy 181 Bette H. Barrier a Division of Yadkin Valley
Jonas Ridge, NC 28641 PO Box 249 Bank and Trust Co.
Jonas Ridge,NC 28641 176 Shadowline Drive
Boone,NC 28607
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 56-1079519 I. SETTLEMENT DATE:
9051 Hwy 181 Byrd Byrd Ervin Whisnant&McMahon,P.A.
Jonas Ridge, NC 28641 October 16,2007
Burke County, North Carolina PLACE OF SETTLEMENT
301 East Meeting Street
Morganton,NC 28655
J. SUMMARY OF BORROWER'S TRANSACTION K.SUMMARY OF SELLER'S TRANSACTION
100, GROSS AMOUNT DUE FROM BORROWERi 400, GROSS AMOUNT DUE TO SELLERR
101. Contract Sales Price ! 1,250,000.00 401. Contract Sales Price 1,250,000.00
102. Personal Property 250,000.00 402. Personal Property 250,000.00
103. Settlement Charges to Borrower Line 1400 5,857.75 403.
104. 404.
105. 405.
Adiustments For Items Ps2ij E2v Seller in advance AdiustmentsFor Items Paid Bv Seller in 5dvance
106. City/Town Taxes to 406. City/Town Taxes to
107. County Taxes 10/17/07 to 01/01/08 1,542.67 407. County Taxes 10/17/07 to 01/01/08 1,542.67
108. Assessments to 408. Assessments to
109. 409.
110. 410.
Ill. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 1,507,400.42 420. GROSS AMOUNT DUE TO SELLER 1 1,501,542.67
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500.REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Deposit or earnest money 501. Excess Deposit See Instructions
202. Principal Amount of New Loans 550,000.00 502. Settlement Charges to Seller Line 1400 2,538.00
203. Existing loans taken subject to 503. Existing loans taken subject to
204. 504. Payoff of first Mortgage to Wachovia Bank 331,707.02
205. 505. Payoff of second Mortgage
206. 506.
207. 507.
208. Purchase Money Note 1,000,000.00 508. Purchase Money Note 1,000,000.00
209. 509.
Adjustments For Items Unpaid By-Teller Adjustments ror Items Unpaid By Seller
210. City/Town Taxes to 510. City/Town Taxes to
211. County Taxes to 511. County Taxes to
212. Assessments to 512. Assessments to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 1,550,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 1,334,245.02
300. CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER:
301. Gross Amount Due From Borrower Line 120 1,507,400.42 601. Gross Amount Due To Seller Line 420 1,501,542.67
302. Less Amount Paid By/For Borrower(Line 220) ( 1,550,000.00) 602. Less Reductions Due Seller(Line 520) ( 1,334,245.02
303. CASH( FROM)( X TO)BORROWER 42,599.58 1603. CASH( X TO)( FROM)SELLER 167,297.65
.21
)
�;iY

Page 2
L.SETTLEMENT CHARGES
700.TOTAL COMMISSION Based on Price e PAID FROM PAID FROM
Division of Commission line 700 as Follows: BORROWER'S SELLER'S
701.$ to FUNDS AT FUNDS AT
702.$ to SETTLEMENT SETTLEMENT
703.Commission Paid at Settlement
704. to
800.ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Origination Fee 0.5000 % to High Country Bank,a Division of Yadkin Valley Ban 2,750.00
802. Loan Discount % to
803. Appraisal Fee to Fred H. Beck&Assoc. ($5,000) POC
804. Flood Certification to High Country Bank,a Division of Yadkin Valley Ban 9.50
805. Lender's Inspection Fee to
806. Mortgage Ins.App. Fee to
807. UCC Fee to High Country Bank,a Division of Yadkin Valley Ban 44.00
808.
809.
810.
811.
900.ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From 10/16/07 to 11/01/07 @ $ /day ( 16 days %)
902. Mortgage Insurance Premium for months to
903. Hazard Insurance Premium for 1.0 years to
904.
905. N.C. Farm Bureau ($3 902 Annual Premium) POC
1000. RESERVES DEPOSITED WITH LENDER
1001.Hazard Insurance months @ $ per month
1002.Mortgage Insurance months @ $ per month
1003. City/Town Taxes months @ $ per month
1004. County Taxes months @ $ per month
1005. Assessments months @ $ per month
1006. months @ $ per month
1007, months @ $ per month
1008. months $ per month
1100.TITLE CHARGES
1101. Settlement or Closing Fee to
1102. Abstract or Title Search to
1103. Title Examination to
1104. Title Insurance Binder to
1105. Document Preparation to
1106. Notary Fees to
1107. Attorney's Fees to Byrd Byrd Ervin Whisnant&McMahon, P.A. 1,500.00
(includes above item numbers:
1108. Title Insurance to Chicago Title Insurance Company 1,341.25
includes above item numbers:
1109. Lender's Coverage $ 550,000.00 1,341.25
1110.Owner's Coverage $ 1,250,000.00
1111.
1112.
1113.
1200.GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 20.00; Mortgage $ 73.00; Releases $ 93.00
1202.City/ oun Tax/Stamps:Deed Mortgage
1203.State Tax/Stamps: Revenue Stamps 2,500.00;Mortgage 2,500.00
1204. Assignment of Leases&Rents to Burke County Register of Deeds 44.00
1205. UCC Termination to NC Secretary of State 38.00
1300.ADDITIONAL SETTLEMENT CHARGES
1301. Survey to
1302. Pest Inspection to
1303. UCC Filing to Burke County Registry 38.00
1304. UCC Filing to NC Secretary of State 38.00
1305.
1400.TOTAL SETTLEMENT CHARGES (Enter on Lines 103,Section J and 502,Section K) 1 5,857.751 2,538.00
By signing page 1 of this statement,the signatories ac nowledge r cejp ofip-cc 7pleted copy of page 2 of this two page statement.
�O L=
Certified to be a true copy. Byrd Byrd Ervin Whisnant&McMahon,P.A.
i
3 Q Settlement Agent
i
(J0263-R31/J0263-R31/11)

ACKNOWLEDGMENT OF RECEIPT OF SETTLEMENT STATEMENT
Borrower: Jonas Ridge Properties, LLC
Seller: Johnny R. Barrier and wife, Bette H. Barrier
Lender: High Country Bank, a Division of Yadkin Valley Bank and Trust Co.
Settlement Agent: Byrd Byrd Ervin Whisnant& McMahon, P.A.
Place of Settlement: 301 East Meeting Street
Morganton, NC 28655
Settlement Date: October 16, 2007
Property Location: 9051 Hwy 181
Jonas Ridge, NC 28641
Burke County, North Carolina
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and
accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify
that I have received a copy of the HUD-1 Settlement Statement.
Jonas R' e Properties, LLC `
J n y R. Bar, ier
President
Bett H. Barrier
ATTEST:
alb
Secre4a /�reasurer
To the best of my knowledge, the HUD-1 Settlement Statement which I have prepared is a true and accurate account of
the funds which were received and have been or will be disbursed by the undersigned as part of the settlement of this
transaction. UNAMCzu
Byrd Byrd Ervin Whisnant& McMahP.A.
Settlement Agent
WARNING: It is a crime to knowingly make false statements to the United States on this or any similar form. Penalties
upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section
1010.
o n ,,i ;i

DISBURSEMENTS SUMMARY / BALANCE SHEET
Borrower: Jonas Ridge Properties, LLC
Seller: Johnny R. Barrier and wife, Bette H. Barrier
Lender: High Country Bank, a Division of Yadkin Valley Bank and Trust Co.
Settlement Agent: Byrd Byrd Ervin Whisnant& McMahon, P.A.
Place of Settlement: 301 East Meeting Street
Morganton, NC 28655
Settlement Date: October 16, 2007
Property Location: 9051 Hwy 181
Jonas Ridge, NC 28641
Burke County, North Carolina
INCOMING FUNDS
High Country Bank,a Division of Yadkin Valley E Loan Funding Amount 550,000.00
Total Incoming Funds 550,000.00
DISBURSEMENTS
NC Secretary of State UCC Termination 38.00
Burke County Registry UCC Filing 38.00
NC Secretary of State UCC Filing 38.00
Wachovia Bank Payoff of first Mortgage 331,707.02
Johnny R. Barrier and Bette H. Barrier Closing Proceeds 167,297.65
Jonas Ridge Properties, LLC Excess Cash to Close 42,599.58
High Country Bank,a Division of Yadkin Valley Bar Loan Closing 2,803.50
Loan Origination Fee 2,750.00
Flood Certification 9.50
UCC Fee 44.00
Byrd Byrd Ervin Whisnant&McMahon, P.A. Settlement Agents Fees 1,500.25
Attorney's Fees 1,500.00
Title Insurance 0.25 .
Chicago Title Insurance Company Title Charges 1,341.00
Title Insurance 1,341.00
Burke County Register of Deeds Government Charges 2,637.00
Recording Fees 93.00
State Tax/Stamps 2,500.00
Assignment of Leases&Rents 44.00
Number of checks - 10 Total Disbursements 550,000.00
(JONAS RIDGE PROPERTIES.PFD/J0263-R31/11)