| CASE NUMBER | I-200-25050-708526 |
| CASE STATUS | Certified |
| RECEIVED DATE | 2/19/2025 |
| DECISION DATE | 2/26/2025 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Developer Specialist |
| SOC CODE | 15-1252.00 |
| SOC TITLE | Software Developers |
| FULL TIME POSITION | Y |
| BEGIN DATE | 8/4/2025 |
| END DATE | 8/3/2028 |
| 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 | HEALTH CARE SERVICE CORPORATION |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 300 E RANDOLPH STREET |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | CHICAGO |
| EMPLOYER STATE | IL |
| EMPLOYER POSTAL CODE | 60601 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 13126536041 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 524210 |
| EMPLOYER POC LAST NAME | VANG |
| EMPLOYER POC FIRST NAME | KENEARY |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | WORKFORCE SOLUTIONS CONSULTANT |
| EMPLOYER POC ADDRESS1 | 1001 E LOOKOUT DR. |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | RICHARDSON |
| EMPLOYER POC STATE | TX |
| EMPLOYER POC POSTAL CODE | 75082 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 19727669014 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | HRC-IMMIGRATION@BCBSIL.COM |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | LU |
| AGENT ATTORNEY FIRST NAME | XIAO |
| AGENT ATTORNEY MIDDLE NAME | |
| AGENT ATTORNEY ADDRESS1 | 333 West Wacker Drive |
| AGENT ATTORNEY ADDRESS2 | Flr 15 |
| AGENT ATTORNEY CITY | Chicago |
| AGENT ATTORNEY STATE | IL |
| AGENT ATTORNEY POSTAL CODE | 60606 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | N/A |
| AGENT ATTORNEY PHONE | 13122636101 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | fragomen-hcsc@fragomen.com |
| LAWFIRM NAME BUSINESS NAME | FRAGOMEN, DEL REY, BERNSEN & LOEWY, LLP |
| STATE OF HIGHEST COURT | NY |
| NAME OF HIGHEST STATE COURT | New York Supreme Court, 3rdAppellateDivision |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 1001 E. Lookout Drive |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Richardson |
| WORKSITE COUNTY | DALLAS |
| WORKSITE STATE | TX |
| WORKSITE POSTAL CODE | 75082 |
| WAGE RATE OF PAY FROM | $149,781.00 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $149,781.00 |
| 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 | 2 |
| 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 | 2025-08-04 |
