NCC192187_Payment Verification_20191007

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/3/2019 10:34:52 AM (NCG01 NOI Submission)
Approve by EADS\smccoy2 10/3/2019 2:45:44 PM (Review- Construction NOI 16668)
• The task was assigned to EADS\smccoy2 by round robin distribution 10/3/2019 10:35 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 7, 2019 5:00
PM 10/3/2019 10:35 AM
Submit by EADS\smccoy2 10/7/2019 8:45:10 AM (Payment Verification for NCC192187)
* Keith Bartlein.
• EADS\smccoy2 assigned the task to EADS\smccoy2 10/7/2019 8:44 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 14, 2019 5:00
PM 10/3/2019 2:45 PM

NORTH CAROUNA
Emiro mortal Qaafity
Project Tracking ID*
NCC-IREDE-2019-Carolina Specialty Care, LLC
NC Reference No.*
NCG01-2019-2187
Certificate of
NCC192187
Coverage (COC)
No. *
Important: If you change the choice below to Payment NOT RECEIVED, the application will be rejected, and a COC will
not be issued. This is the ONLY way to reject an eNOI at this step.
Payment Received* r Payment Received.
r Payment NOT RECEIVED.
Date Payment
10/7/2019
Received*
Method of Payment*
r electronic
r check
r NO PAYMENT RECEIVED
r Other
e Payme nt
482724685
Transaction
Number*
NOI Tracking No.
16668
Tracking ID referenced upon suba ttal
This is an Express
r No
Review Project
r Yes