| CASE NUMBER | I-200-24082-824526 |
| CASE STATUS | Certified |
| RECEIVED DATE | 3/22/2024 |
| DECISION DATE | 3/29/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Electrical Engineer |
| SOC CODE | 17-2071.00 |
| SOC TITLE | Electrical Engineers |
| FULL TIME POSITION | Y |
| BEGIN DATE | 9/21/2024 |
| END DATE | 9/20/2027 |
| 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 | KCKC Medical Group, LLC |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 500 Warnke Road |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | Michigan City |
| EMPLOYER STATE | IN |
| EMPLOYER POSTAL CODE | 46360 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 18157353100 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 811210 |
| EMPLOYER POC LAST NAME | Dieterle |
| EMPLOYER POC FIRST NAME | James |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | President |
| EMPLOYER POC ADDRESS1 | 500 Warnke Road |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | Michigan City |
| EMPLOYER POC STATE | IN |
| EMPLOYER POC POSTAL CODE | 46360 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 18157353100 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | r.dieterle@kckcmedical.com |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Lara |
| AGENT ATTORNEY FIRST NAME | Wendy |
| AGENT ATTORNEY MIDDLE NAME | Z |
| AGENT ATTORNEY ADDRESS1 | 4843 W Cermak Road |
| AGENT ATTORNEY ADDRESS2 | |
| AGENT ATTORNEY CITY | Cicero |
| AGENT ATTORNEY STATE | IL |
| AGENT ATTORNEY POSTAL CODE | 60804 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 17086521500 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | Wendy@connielara.com |
| LAWFIRM NAME BUSINESS NAME | Constance H. Lara, PC |
| STATE OF HIGHEST COURT | IL |
| NAME OF HIGHEST STATE COURT | Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 500 Warnke Road |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Michigan City |
| WORKSITE COUNTY | LA PORTE |
| WORKSITE STATE | IN |
| WORKSITE POSTAL CODE | 46360 |
| WAGE RATE OF PAY FROM | 80600 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | $85,000.00 |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $80,600.00 |
| 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 | 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 | 2025-09-09 |
