| CASE NUMBER | I-200-24130-977363 |
| CASE STATUS | Certified |
| RECEIVED DATE | 5/9/2024 |
| DECISION DATE | 5/16/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Physician (Dermatology) |
| SOC CODE | 29-1213.00 |
| SOC TITLE | Dermatologists |
| FULL TIME POSITION | N |
| BEGIN DATE | 5/13/2024 |
| END DATE | 5/12/2027 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 1 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | Oliver Street 5.01(a) Inc. |
| TRADE NAME DBA | U.S. Dermatology Partners |
| EMPLOYER ADDRESS1 | 5310 Harvest Hill Road |
| EMPLOYER ADDRESS2 | Suite 290 |
| EMPLOYER CITY | Dallas |
| EMPLOYER STATE | TX |
| EMPLOYER POSTAL CODE | 75230 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 12144200655 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 6211 |
| EMPLOYER POC LAST NAME | Tilley |
| EMPLOYER POC FIRST NAME | Justin |
| EMPLOYER POC MIDDLE NAME | B. |
| EMPLOYER POC JOB TITLE | Chief Legal Officer |
| EMPLOYER POC ADDRESS1 | 5310 Harvest Hill Road |
| EMPLOYER POC ADDRESS2 | Suite 290 |
| EMPLOYER POC CITY | Dallas |
| EMPLOYER POC STATE | TX |
| EMPLOYER POC POSTAL CODE | 75230 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 12144200655 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | jtilley@usdermpartners.com |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Ramsey |
| AGENT ATTORNEY FIRST NAME | Lindsay |
| AGENT ATTORNEY MIDDLE NAME | Carlberg |
| AGENT ATTORNEY ADDRESS1 | 500 N. Meridian Street |
| AGENT ATTORNEY ADDRESS2 | Suite 400 |
| AGENT ATTORNEY CITY | Indianapolis |
| AGENT ATTORNEY STATE | IN |
| AGENT ATTORNEY POSTAL CODE | 46204 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 13174293637 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | lramsey@hallrender.com |
| LAWFIRM NAME BUSINESS NAME | Hall, Render, Killian, Heath & Lyman, P.C. |
| STATE OF HIGHEST COURT | IN |
| NAME OF HIGHEST STATE COURT | Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 5310 Harvest Hill Road |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Dallas |
| WORKSITE COUNTY | DALLAS |
| WORKSITE STATE | TX |
| WORKSITE POSTAL CODE | 75230 |
| WAGE RATE OF PAY FROM | 135 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Hour |
| PREVAILING WAGE | $115.00 |
| PW UNIT OF PAY | Hour |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | N/A |
| PW OES YEAR | 7/1/2023 - 6/30/2024 |
| 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 | 2025-01-05 |
