NC0047759_Owner (Name Change)_20240318

MSTAT��
ROY COOPER�i-
Govemor
ELIZABETH S. BISER.
Secretary
RICHARD E. ROGERS,,JR. NORTH CAROLINA
Director Environmental Quality
PERMIT NAME/OWNERSHIP CHANGE FORM
CURRENT PERMIT INFORMATION:
Permit Number: NC00 4 / 7 / 7 / 5 / 9 or NCGS / / / /
1. Facility Name: PruittHealth — Sea Level, LLC
NEW OWNER/NAME INFORMATION:
1. This request for a name change is a result of:
_X_a. Change in ownership of property/company
b. Name change only
c. Other (please explain):
2. New owner's name (name to be put on permit):
Integrated Care of Greater Hickory, Inc.
RECEIVED
ViAR 8 L`1jZ4
NCDEO/DWR/NPDES
3. New owner's or signing official's name and title: Corey Richardson
(Person legally responsible for permit)
4. Mailing address: 741 51 St. SW
State: NC Zip Code:28602
Phone: [phone]
E-mail address: crichardsonlc'i integratedcarehickory.com
CEO
(Title)
City: Hickory
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION UNLESS ALL OF THE
APPLICABLE ITEMS LISTED BELOW ARE INCLUDED WITH THE SUBMITTAL.
REQUIRED ITEMS:
1. This completed application form
2. Legal documentation of the transfer of ownership (such as a property deed, articles of
incorporation, or sales agreement)
[see reverse side of this page for signature requirements]
D E Q J� North Carolina Department of Environmental Quality (Division of Water Resources
512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolina 27699-1617
NOR M CAROLINA 919.707.9000
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Page 2 of 2
Applicant's Certification:
I, Corey Richardson , attest that this application
for a name/ownership change has been reviewed 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 and attachments are not included, this application
package will be returned incomplete.
Signature: j Date:
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING
INFORMATION & MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDDRESS:
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Gore`! RP e5\6 ego G N NG Zg6
`egiatie
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NC DEQ / DWR / NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617

J-
LEASE AGREEMENT
STATE OF NORTH CAROLINA
COUNTY OF CARTERET
THIS LEASE AGREEMENT made and entered into this l V day of 01 2023 by and between
the Carteret County Government (hereinafter referred to as "Lessor"), and Integrated Health Care of
Greater Hickory, (hereinafter referred to as "Lessee");
WITNESSETH:
THAT WHEREAS Lessor has agreed to lease to Lessee and Lessee has agreed to lease from Lessor the
following premises consisting of certain buildings (the "Building") located at 468 Highway 70 East, Sea
Level, Carteret County, North Carolina and the approximately 16-acre tract of land upon which the
Building is located (the MmL and together with the Building, and rights of access, and easements
thereto, including ingress and egress over and across the Land, the "Leased Preen_ ises") The Land is
more particularly described on Exhibit hereto. Notwithstanding the foregoing, in no event shall the
'remises be deemed to include such portions of the Land upon which is situated those buildings on
the Land having the following addresses: 440 and 458 Highway 70 East, Sea Level, Carteret County,
North Carolina. In consideration of the Rent (as defined below) to be paid by Lessee to Lessor, and
agreements set forth herein, Lessor hereby leases to Lessee the Leased Premises.
The said lease is subject to the following terms and conditions:
RENTAL. Rental shall be $1.00 per month for the initial term of this Lease being paid upon the execution of this
Lease on the 18' day of each month The Lessee will also provide all maintenance for all buildings,
piechanical, and other repair within the leased area, except; in the case of a catastrophic failure of a major
Building system during the first two years of the lease, the Lessor shall make reimbursement to the Lessee
rot to exceed $300,000.00 per year. After the first two years of the lease the Lessee shall bear all of the
r iaintenance cost with no participation from the Lessor.
Catastrophic failure shall be defined as a single incident causing failure of a major building system,
including and limited to Electrical, HVAC, Fire Suppression, or Structural that renders the building
inoperable or unusable and costing more than $100,000.00 to repair or replace.
a) T 1 The initial term of this Lease shall be from January 1, 2024 until December 31,.2033 with the option to
rene two 120-month renewals from January 1, 2034- December 31, 2043 and Januaryl, 2044-December 31,
2053. Said lease shall renew automatically unless Lessee
before the end of a term of its intent not to renew. notifies Lessor within one hundred eighty (180) days
Lessee shall be responsible for all maintenance and upkeep required for the property and building as long as
this Lease remains in effect; except for during the first two years of the lease as detailed above in 1. Rental.
Lessee agrees to hold Lessor harmless from any and all personal injury, liability claims arising or associated
with the Lease of this property, and will ensure that said property is insured in those amounts as deemed
adequate by Lessor.

b) Termination. This lease may be terminated at any time during the Term by mutual written consent of both the
Lessor and Lessee
This Lease will not be modified, except in writing, no oral amendments are valid.
After the initial term and two automatic 120-month renewal options the Lease may be terminated by either
party by giving thirty (30) days' written notice to the other.
c) Taxes. Lessor represents and covenants to Lessee that during the Term there shall be no Ad valorem real-
estate taxes imposed or assessed against the leased premises. Lessee shall be solely responsible for payment
of any and all taxes , fees, and assessments imposed upon the Lessees income, business operations, equipment,
fixtures, and other personal property or assets.
d) Alterations. Lessee shall make no structural changes, additions, or improvements to the Leased Premises,
without the prior written consent of Lessor, not to be unreasonably withheld, conditioned or delayed. Lessee
shall be permitted to otherwise make any non-structural changes or other alterations, additions, or
improvements to the Leased Premises which are not in excess of $25,000.00. Such alterations or
improvements shall not impair or diminish the present or future value of the Leased Premises, and the Leased
Premises will not be rendered unsafe by such alterations or improvements.
e) Assignment; Subletting. Lessee shall not, without the prior consent of Lessor, which consent may be withheld
in Lessor's sole discretion, assign this Lease or any interest herein in whole or in part, or sublet all or any
portion of the Leased Premises, or mortgage, pledge, encumber, hypothecate, or otherwise transfer the
Leased Premises or any part thereof, or permit the use of the Leased Premises by any party other than
Lessee, its employees, and independent contractors engaged in the operation of the Facility.
Notwithstanding the foregoing, Lessee may assign this Lease, without Lessor's consent, to an affiliate or
subsidiary.
f) As shown in Exhibit A the Pharmacy and Quick Care operated by Carteret Health Care is not included in the
lease at the time of execution of this document. At some point in the future if Carteret Health Care or the
Pharmacy does not elect to continue to provide service these portions of the facility may be included if
mutually agreeable in writing by both parties.
IN TESTIMONY WHEREOF, said parties have hereunto set their hands and seals this day and year first above
written.
LESSEE:
LESSOR:
__(SEAL)
EO Of Organization
C 7av4(SEAL)
Jimmy Farringto , Chairman
Carteret County Board of Commissioners
Corey Richardson, DHSc, MBA
President and CEO
Integrated Care of Greater Hickory
741 5th St SW, Hickory NC 26602

STATEOF NORTH CAROLINA
COUNTY OF CARTERET
I I No
Public of the County and State aforesaid, do hereby certify that
CEO of Organization pers ally appeared before me this day and executed the foregoing instrument for
and on behalf of the Lessor, and that they acknowledged the execution of the foregoing instrument for the
propose therein expressed for and in behalf of the said owner.
Witness my hand and notarial seal, this h6day of ifOrn . 2023.
401:nmilsion Expires:
STATE OF NORTH CAROLINA
COUNTY OF CARTERET
oVa�ublic
M
KENSHIPicCarolinaAug. 2, 2027
I 1'•' �' ''t- , Notary Public of the County and State aforesaid, do hereby certify that
Jimmy Farrington personally appeared before me this day and executed the foregoing instrument for and
on behalf of The County of Carteret, and that he acknowledged the execution of the foregoing instrument
for the purpose therein expressed for and in the behalf of the said County of Carteret.
Witness my hand and notarial seal, this 2' day ofX-4-0 �— -�023.
My Commiss}on Expires:
Notary Public
LORI R TURNER
NOTARY PUBLIC
Carteret County
North Carolina
My Commission Expires May 18, 2026 ' z .r�M