EFTA Document EFTA01281868

I V BlueCross IilucShleld of North Carolina' Pal Ones IkA 0..MsmbwGVn urnteet EIGHTY.ONE DOLLARS AND EIGHTY CENTS • PAY TO THE V.WortipividdA Claims Payment • in-n T40- 5009957 Vold aflAr sbc MonlAs Mora th. • sat.101 /4/644 Troasuret. Blue CAMS ard Moo WSJ ol North Caolia 'Aalndopondsol Worm. of Ise Glue Cross And GAN VISO *Asada :on "TOO 5009 95 ?I' 80 180 L 405 3' CONFIDENTIAL SDNY_GM_00036858 EFTA_00 147471 EFTA01281868 e • / J .c - ••• CONFIDENTIAL SDNY_GM_