| CASE NUMBER | I-200-25003-594266 |
| CASE STATUS | Certified |
| RECEIVED DATE | 1/3/2025 |
| DECISION DATE | 1/13/2025 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Manager, Quality Assurance (QA) - GCP |
| SOC CODE | 13-1041.00 |
| SOC TITLE | Compliance Officers |
| FULL TIME POSITION | Y |
| BEGIN DATE | 2/1/2025 |
| END DATE | 1/31/2028 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 1 |
| EMPLOYER NAME | TrialSpark, Inc. d/b/a Formation Bio |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 16 East 34th Street |
| EMPLOYER ADDRESS2 | 10th Floor |
| EMPLOYER CITY | New York |
| EMPLOYER STATE | NY |
| EMPLOYER POSTAL CODE | 10016 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 16468672932 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 541715 |
| EMPLOYER POC LAST NAME | Enbar |
| EMPLOYER POC FIRST NAME | Melissa |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | Chief People Officer |
| EMPLOYER POC ADDRESS1 | 16 East 34th Street |
| EMPLOYER POC ADDRESS2 | Floor 10 |
| EMPLOYER POC CITY | New York |
| EMPLOYER POC STATE | NY |
| EMPLOYER POC POSTAL CODE | 10016 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 16317669620 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | melissa@formation.bio |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Brown |
| AGENT ATTORNEY FIRST NAME | David |
| AGENT ATTORNEY MIDDLE NAME | Zaritzky |
| AGENT ATTORNEY ADDRESS1 | 8001 S. 13th Street |
| AGENT ATTORNEY ADDRESS2 | |
| AGENT ATTORNEY CITY | Lincoln |
| AGENT ATTORNEY STATE | NE |
| AGENT ATTORNEY POSTAL CODE | 68512 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 14023289899 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | dol@brownimmigrationlaw.com |
| LAWFIRM NAME BUSINESS NAME | Brown Immigration Law P.C., L.L.O. |
| STATE OF HIGHEST COURT | CA |
| NAME OF HIGHEST STATE COURT | Supreme Court of California |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 410 S. Maple Ave |
| WORKSITE ADDRESS2 | Apt 506 |
| WORKSITE CITY | Falls Church |
| WORKSITE COUNTY | FALLS CHURCH CITY |
| WORKSITE STATE | VA |
| WORKSITE POSTAL CODE | 22046 |
| WAGE RATE OF PAY FROM | $140,000.00 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | $185,000.00 |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $79,290.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | II |
| 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 | |
| PREPARER FIRST NAME | |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | |
| PREPARER EMAIL | |
| BEGIN DATE CONVERTED | 2025-02-01 |
