Form N-04 - Articles Of Merger Nonprofit Corporation/hospital Author - 2000


State of North Carolina
Department of the Secretary of State
Pursuant to
55A-11-10 of the General Statutes of North Carolina, the undersigned corporation/Hospital Authority does hereby
submit the following Articles of Merger as the surviving corporation in a merger between a domestic Hospital Authority and
another Hospital Authority or a charitable or religious nonprofit corporation.
1. The name of the surviving corporation/Hospital Authority is ___________________________________________,
a corporation/Hospital Authority organized under the laws of ________________*, North Carolina; the name of the
merged Hospital Authority is:
_______________________________________________________, a Hospital Authority organized under the laws of
_______________,* North Carolina. (*provide the name of the city and county that the Hospital Authority is formed in)
2. Attached is a copy of the Plan of Merger that was duly approved in the manner prescribed by law for each of
the corporations/Hospital Authorities participating in the merger.
** (Complete item 3 if the surviving entity is a charitable or religious corporation, complete item 4 if the surviving entity is a
county Hospital Authority)
3. With respect to the surviving charitable or religious corporation (check either a, b, and/or c, as applicable):
a.___ Member approval was not required for the merger, and the plan of merger was approved by a sufficient vote of the
board of directors.
b.___ Member approval was required for the merger, and the plan of merger was approved by the members as required by
Chapter 55A of the North Carolina General Statutes.
c.___ Approval of the plan of merger by some person or persons other than the members or the board was required pursuant
to N.C.G.S. Section 55A-11-03(a)(3), and such approval was obtained.
A plan of merger was approved by the city and by a majority of the members of the board of commissioner of the city
Hospital Authority.
4. ____ A plan of merger was approved by the city and the county, and a majority of each of the boards of commissioners of
the Hospital Authorities.
5. These articles will be effective upon filing, unless a delayed date and/or time is specified: ____________________________
This is the _____day of ________________, 20___.
Name of Corporation
Type or Print Name and Title
1. Filing fee is $25. This document and one exact or conformed copy of these articles must be filed with the Secretary of State.
2. Certificate(s) of Merger must be registered pursuant to the requirements of N.C.G.S. Section 47-18.1.
(Revised January 2000)
(Form N-04)
P.O. BOX 29622
RALEIGH, NC 27626-0622


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