| CASE NUMBER | I-200-25056-722171 |
| CASE STATUS | Certified |
| RECEIVED DATE | 2/25/2025 |
| DECISION DATE | 3/4/2025 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Internal Medicine Physician |
| SOC CODE | 29-1216.00 |
| SOC TITLE | General Internal Medicine Physicians |
| FULL TIME POSITION | Y |
| BEGIN DATE | 8/19/2025 |
| END DATE | 8/18/2028 |
| 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 | KentuckyOne Health Medical Group |
| TRADE NAME DBA | Saint Joseph Medical Group |
| EMPLOYER ADDRESS1 | 1401 Harrodsburg Road, Building B, Suite 485 |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | Lexington |
| EMPLOYER STATE | KY |
| EMPLOYER POSTAL CODE | 40504 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 18593131713 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 621111 |
| EMPLOYER POC LAST NAME | Jones |
| EMPLOYER POC FIRST NAME | Carmel |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | President |
| EMPLOYER POC ADDRESS1 | 1401 Harrodsburg Road, Building B, Suite 485 |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | Lexington |
| EMPLOYER POC STATE | KY |
| EMPLOYER POC POSTAL CODE | 40504 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 18593131715 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | carmel.jones@commonspirit.org |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Bell |
| AGENT ATTORNEY FIRST NAME | Jeffrey |
| AGENT ATTORNEY MIDDLE NAME | S |
| AGENT ATTORNEY ADDRESS1 | 900 West 48th Place |
| AGENT ATTORNEY ADDRESS2 | Suite 900 |
| AGENT ATTORNEY CITY | Kansas City |
| AGENT ATTORNEY STATE | MO |
| AGENT ATTORNEY POSTAL CODE | 64112 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | MO |
| AGENT ATTORNEY PHONE | 18163604264 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | jbell@polsinelli.com |
| LAWFIRM NAME BUSINESS NAME | Polsinelli |
| STATE OF HIGHEST COURT | MO |
| NAME OF HIGHEST STATE COURT | Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 165 London Mountain View Drive |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | London |
| WORKSITE COUNTY | LAUREL |
| WORKSITE STATE | KY |
| WORKSITE POSTAL CODE | 40741 |
| WAGE RATE OF PAY FROM | $250,000.00 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $239,200.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | N/A |
| PW OES YEAR | 7/1/2024 - 6/30/2025 |
| 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 | |
| PREPARER FIRST NAME | |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | |
| PREPARER EMAIL | |
| BEGIN DATE CONVERTED | 2025-08-19 |
