| CASE NUMBER | I-200-23272-394141 |
| CASE STATUS | Certified |
| RECEIVED DATE | 9/29/2023 |
| DECISION DATE | 10/6/2023 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Physician Assistant (PA) |
| SOC CODE | 29-1071.00 |
| SOC TITLE | Physician Assistants |
| FULL TIME POSITION | Y |
| BEGIN DATE | 3/1/2024 |
| END DATE | 2/28/2027 |
| 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 | Bon Secours Community Hospital |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 160 E. Main Street |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | Port Jervis |
| EMPLOYER STATE | NY |
| EMPLOYER POSTAL CODE | 12771 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 18458587000 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 622110 |
| EMPLOYER POC LAST NAME | Kukowski |
| EMPLOYER POC FIRST NAME | Barbara |
| EMPLOYER POC MIDDLE NAME | F. |
| EMPLOYER POC JOB TITLE | Senior Vice President and Deputy General Counsel |
| EMPLOYER POC ADDRESS1 | 19 Bradhurst Avenue |
| EMPLOYER POC ADDRESS2 | Suite 3080N |
| EMPLOYER POC CITY | Hawthorne |
| EMPLOYER POC STATE | NY |
| EMPLOYER POC POSTAL CODE | 10532 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 19144932929 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | priscila.hess@wmchealth.org |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | D'Arrigo |
| AGENT ATTORNEY FIRST NAME | Leonard |
| AGENT ATTORNEY MIDDLE NAME | John |
| AGENT ATTORNEY ADDRESS1 | 677 Broadway |
| AGENT ATTORNEY ADDRESS2 | Suite 1101 |
| AGENT ATTORNEY CITY | Albany |
| AGENT ATTORNEY STATE | NY |
| AGENT ATTORNEY POSTAL CODE | 12207 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 15187012770 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | immigrationhb@harrisbeach.com |
| LAWFIRM NAME BUSINESS NAME | Harris Beach PLLC |
| STATE OF HIGHEST COURT | NY |
| NAME OF HIGHEST STATE COURT | Court of Appeals |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 160 E. Main Street |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Port Jervis |
| WORKSITE COUNTY | ORANGE |
| WORKSITE STATE | NY |
| WORKSITE POSTAL CODE | 12771 |
| WAGE RATE OF PAY FROM | 133910.4 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $125,174.00 |
| 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 | Asala |
| PREPARER FIRST NAME | Mary |
| PREPARER MIDDLE INITIAL | R |
| PREPARER BUSINESS NAME | Harris Beach PLLC |
| PREPARER EMAIL | masala@harrisbeach.com |
| BEGIN DATE CONVERTED | 2024-01-03 |
