| CASE NUMBER | I-200-24365-577286 |
| CASE STATUS | Certified |
| RECEIVED DATE | 12/30/2024 |
| DECISION DATE | 1/7/2025 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Athletic Trainer |
| SOC CODE | 29-9091.00 |
| SOC TITLE | Athletic Trainers |
| FULL TIME POSITION | Y |
| BEGIN DATE | 1/13/2025 |
| END DATE | 1/12/2028 |
| 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 | Penn State Health Community Medical Group, LLC |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 100 Crystal A Drive, P.O. Box 804 |
| EMPLOYER ADDRESS2 | Mail Code CA230 |
| EMPLOYER CITY | Hershey |
| EMPLOYER STATE | PA |
| EMPLOYER POSTAL CODE | 17033 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 17175310003 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 622110 |
| EMPLOYER POC LAST NAME | Mummert |
| EMPLOYER POC FIRST NAME | Erin |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | Lead HR Compliance Specialist |
| EMPLOYER POC ADDRESS1 | 100 Crystal A Drive, P.O. Box 804 |
| EMPLOYER POC ADDRESS2 | Mail Code CA230 |
| EMPLOYER POC CITY | Hershey |
| EMPLOYER POC STATE | PA |
| EMPLOYER POC POSTAL CODE | 17033 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 17175310003 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | emummert@pennstatehealth.psu.edu |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Pollins |
| AGENT ATTORNEY FIRST NAME | Karen |
| AGENT ATTORNEY MIDDLE NAME | |
| AGENT ATTORNEY ADDRESS1 | 101 Greenwood Avenue |
| AGENT ATTORNEY ADDRESS2 | Suite 630 |
| AGENT ATTORNEY CITY | Jenkintown |
| AGENT ATTORNEY STATE | PA |
| AGENT ATTORNEY POSTAL CODE | 19046 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 12158853600 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | karen@goldblumfirm.com |
| LAWFIRM NAME BUSINESS NAME | Goldblum, Pollins & Dennis, P.C. |
| STATE OF HIGHEST COURT | PA |
| NAME OF HIGHEST STATE COURT | Pennsylvania Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | Yes |
| SECONDARY ENTITY BUSINESS NAME | Central Dauphin School District |
| WORKSITE ADDRESS1 | Lancaster Medical Group Administration “ Therapy Services |
| WORKSITE ADDRESS2 | 30 Hope Drive, Entrance B |
| WORKSITE CITY | Hershey |
| WORKSITE COUNTY | DAUPHIN |
| WORKSITE STATE | PA |
| WORKSITE POSTAL CODE | 17033 |
| WAGE RATE OF PAY FROM | $43,680.00 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $43,280.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | I |
| PW OES YEAR | 7/1/2024 - 6/30/2025 |
| 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 | 2025-01-13 |
