| CASE NUMBER | I-200-24319-474886 |
| CASE STATUS | Certified |
| RECEIVED DATE | 11/14/2024 |
| DECISION DATE | 11/21/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Director, Medical Benefit Management |
| SOC CODE | 11-1021 |
| SOC TITLE | General and Operations Management |
| FULL TIME POSITION | Y |
| BEGIN DATE | 5/3/2025 |
| END DATE | 5/2/2028 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 1 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | Blue Cross Blue Shield of Michigan |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 600 E. Lafayette Blvd. |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | Detroit |
| EMPLOYER STATE | MI |
| EMPLOYER POSTAL CODE | 48226 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 13132255960 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 524114 |
| EMPLOYER POC LAST NAME | Busovicki |
| EMPLOYER POC FIRST NAME | Mike |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | Manager, Talent Acquisition |
| EMPLOYER POC ADDRESS1 | 600 E. Lafayette Blvd. |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | Detroit |
| EMPLOYER POC STATE | MI |
| EMPLOYER POC POSTAL CODE | 48226 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 13132255960 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | mbusovicki@bcbsm.com |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Drozdowski |
| AGENT ATTORNEY FIRST NAME | Andrew |
| AGENT ATTORNEY MIDDLE NAME | |
| AGENT ATTORNEY ADDRESS1 | P.O. Box 31608 |
| AGENT ATTORNEY ADDRESS2 | |
| AGENT ATTORNEY CITY | Raleigh |
| AGENT ATTORNEY STATE | NC |
| AGENT ATTORNEY POSTAL CODE | 27622 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 19197879700 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | Andrew.Drozdowski@ogletreedeakins.com |
| LAWFIRM NAME BUSINESS NAME | Ogletree Deakins |
| STATE OF HIGHEST COURT | NC |
| NAME OF HIGHEST STATE COURT | Supreme Court of North Carolina |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | Tower 500 Renaissance Center |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Detroit |
| WORKSITE COUNTY | WAYNE |
| WORKSITE STATE | MI |
| WORKSITE POSTAL CODE | 48243 |
| WAGE RATE OF PAY FROM | $164,528.00 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | $198,602.35 |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $164,528.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | IV |
| PW OES YEAR | 7/1/2024 - 6/30/2025 |
| PW OTHER SOURCE | |
| PW OTHER YEAR | |
| PW SURVEY PUBLISHER | |
| PW SURVEY NAME | |
| TOTAL WORKSITE LOCATIONS | 1 |
| AGREE TO LC STATEMENT | Yes |
| H 1B DEPENDENT | No |
| WILLFUL VIOLATOR | No |
| SUPPORT H1B | N/A |
| STATUTORY BASIS | |
| APPENDIX A ATTACHED | N/A |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | Drozdowski |
| PREPARER FIRST NAME | Andrew |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | Ogletree Deakins |
| PREPARER EMAIL | jessica.altekruse@ogletreedeakins.com |
| BEGIN DATE CONVERTED | 2025-05-03 |
