| LCA CASE NUMBER | I-200-21141-334393 |
| STATUS | Certified - Withdrawn |
| LCA CASE SUBMIT | 2021-05-21 |
| DECISION DATE | 2021-06-16 |
| ORIGINAL CERT DATE | 2021-05-28 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | Sr. Software Engineer |
| SOC CODE | 15-1132.00 |
| SOC TITLE | Software Developers, Applications |
| FULL TIME POSITION | True |
| LCA CASE EMPLOYMENT START DATE | 2021-06-21 |
| END DATE | 2024-06-20 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 1 |
| AMENDED PETITION | 0 |
| LCA CASE EMPLOYER NAME | GREAT WEST LIFE & ANNUITY INSURANCE COMPANY |
| TRADE NAME DBA | EMPOWER RETIREMENT |
| EMPLOYER ADDRESS1 | 8515 EAST ORCHARD ROAD |
| EMPLOYER CITY | GREENWOOD VILLAGE |
| EMPLOYER STATE | CO |
| EMPLOYER POSTAL CODE | 80111 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 13037354155 |
| NAICS CODE | 524210 |
| EMPLOYER POC LAST NAME | Medaris |
| EMPLOYER POC FIRST NAME | Tony |
| EMPLOYER POC JOB TITLE | Senior Specialist, HR Operations Support Team |
| EMPLOYER POC ADDRESS 1 | 8515 East Orchard Road |
| EMPLOYER POC ADDRESS 2 | Ste. 3T2 |
| EMPLOYER POC CITY | Greenwood Village |
| EMPLOYER POC STATE | CO |
| EMPLOYER POC POSTAL CODE | 80111 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 13037372449 |
| EMPLOYER POC EMAIL | tony.medaris@empower-retirement.com |
| AGENT REPRESENTING EMPLOYER | True |
| AGENT ATTORNEY LAST NAME | OCHOA |
| AGENT ATTORNEY FIRST NAME | ANGELICA |
| AGENT ATTORNEY MIDDLE NAME | MARIA |
| AGENT ATTORNEY ADDRESS1 | 1125 17TH ST |
| AGENT ATTORNEY ADDRESS2 | SUITE 2400 |
| AGENT ATTORNEY CITY | DENVER |
| AGENT ATTORNEY STATE | CO |
| AGENT ATTORNEY POSTAL CODE | 80202 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PHONE | 13032183669 |
|
| AGENT ATTORNEY EMAIL ADDRESS | aochoa@fisherphillips.com |
| LAWFIRM NAME BUSINESS NAME | FISHER & PHILLIPS LLP |
| STATE OF HIGHEST COURT | CO |
| NAME OF HIGHEST STATE COURT | COLORADO SUPPREME COURT |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | False |
| WORKSITE ADDRESS1 | 28 Apollo Rd., Apt. 5H |
| LCA CASE WORKLOC1 CITY | East Providence |
| WORKSITE COUNTY | PROVIDENCE CITY |
| LCA CASE WORKLOC1 STATE | RI |
| WORKSITE POSTAL CODE | 2914 |
| LCA CASE WAGE RATE FROM | 160000 |
| LCA CASE WAGE RATE UNIT | Year |
| PREVAILING WAGE | 126672 |
| PW UNIT OF PAY | Year |
| PW WAGE LEVEL | IV |
| PW OES YEAR | 7/1/2020 - 6/30/2021 |
| TOTAL WORKSITE LOCATIONS | 1 |
| AGREE TO LC STATEMENT | True |
| H1B DEPENDENT | False |
| WILLFUL VIOLATOR | False |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | Bohman |
| PREPARER FIRST NAME | Kelly |
| PREPARER MIDDLE INITIAL | M |
| PREPARER BUSINESS NAME | Fisher & Phillips LLP |
| PREPARER EMAIL | kbohman@fisherphillips.com |
