| CASE NUMBER | I-200-24176-142540 |
| CASE STATUS | Certified |
| RECEIVED DATE | 6/24/2024 |
| DECISION DATE | 7/1/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Boys Youth Development Phase Leader &Club Technical Director |
| SOC CODE | 27-2022.00 |
| SOC TITLE | Coaches and Scouts |
| FULL TIME POSITION | Y |
| BEGIN DATE | 10/1/2024 |
| END DATE | 9/30/2027 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 1 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | Impact FC, Inc. |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | P.O. Box 332 |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | Statesville |
| EMPLOYER STATE | NC |
| EMPLOYER POSTAL CODE | 28687 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | +19805490038 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 711211 |
| EMPLOYER POC LAST NAME | Grover |
| EMPLOYER POC FIRST NAME | Jim |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | IFC Treasurer |
| EMPLOYER POC ADDRESS1 | P.O. Box 332 |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | Statesville |
| EMPLOYER POC STATE | NC |
| EMPLOYER POC POSTAL CODE | 28687 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | +17045005204 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | treasurer@impactfcnc.com |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Castrodale |
| AGENT ATTORNEY FIRST NAME | Alexander |
| AGENT ATTORNEY MIDDLE NAME | R |
| AGENT ATTORNEY ADDRESS1 | 625 Liberty Avenue |
| AGENT ATTORNEY ADDRESS2 | Floor 5 |
| AGENT ATTORNEY CITY | Pittsburgh |
| AGENT ATTORNEY STATE | PA |
| AGENT ATTORNEY POSTAL CODE | 15222 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | +14122974712 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | alex.castrodale@dentons.com |
| LAWFIRM NAME BUSINESS NAME | Dentons Cohen & Grigsby, P.C. |
| STATE OF HIGHEST COURT | PA |
| NAME OF HIGHEST STATE COURT | Supreme Court of Pennsylvania |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 2012 Simonton Road |
| WORKSITE ADDRESS2 | Home Soccer Field, Statesville Soccer Complex |
| WORKSITE CITY | Statesville |
| WORKSITE COUNTY | IREDELL |
| WORKSITE STATE | NC |
| WORKSITE POSTAL CODE | 28625 |
| WAGE RATE OF PAY FROM | 44,473.00 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $44,473.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | II |
| PW OES YEAR | 7/1/2023 - 6/30/2024 |
| 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 | Hartman |
| PREPARER FIRST NAME | Jessica |
| PREPARER MIDDLE INITIAL | R |
| PREPARER BUSINESS NAME | Dentons Cohen & Grigsby P.C. |
| PREPARER EMAIL | jessica.hartman@dentons.com |
| BEGIN DATE CONVERTED | 2024-01-10 |
