| CASE NUMBER | I-200-24292-418375 |
| CASE STATUS | Certified |
| RECEIVED DATE | 10/18/2024 |
| DECISION DATE | 10/25/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Medical Technologist |
| SOC CODE | 29-2011.00 |
| SOC TITLE | Medical and Clinical Laboratory Technologists |
| FULL TIME POSITION | Y |
| BEGIN DATE | 1/6/2025 |
| END DATE | 1/5/2028 |
| 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 | Keefe Memorial Health Service District |
| TRADE NAME DBA | Keefe Memorial Hospital |
| EMPLOYER ADDRESS1 | 602 N. 6th Street W |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | Cheyenne Wells |
| EMPLOYER STATE | CO |
| EMPLOYER POSTAL CODE | 80810 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 17197675661 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 622110 |
| EMPLOYER POC LAST NAME | Dowling |
| EMPLOYER POC FIRST NAME | Madisyn |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | Human Resources |
| EMPLOYER POC ADDRESS1 | 602 N. 6th Street W |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | Cheyenne Wells |
| EMPLOYER POC STATE | CO |
| EMPLOYER POC POSTAL CODE | 80810 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 17197675661 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | mdowling@keefemh.org |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Stockdale |
| AGENT ATTORNEY FIRST NAME | Kara |
| AGENT ATTORNEY MIDDLE NAME | Elizabeth |
| AGENT ATTORNEY ADDRESS1 | 1700 Farnam Street |
| AGENT ATTORNEY ADDRESS2 | Suite 1500 |
| AGENT ATTORNEY CITY | Omaha |
| AGENT ATTORNEY STATE | NE |
| AGENT ATTORNEY POSTAL CODE | 68102 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 14023440500 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | kstockdale@bairdholm.com |
| LAWFIRM NAME BUSINESS NAME | Baird Holm LLP |
| STATE OF HIGHEST COURT | NE |
| NAME OF HIGHEST STATE COURT | Nebraska Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 602 N. 6th Street W |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Cheyenne Wells |
| WORKSITE COUNTY | CHEYENNE |
| WORKSITE STATE | CO |
| WORKSITE POSTAL CODE | 80810 |
| WAGE RATE OF PAY FROM | $70,312.32 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $56,368.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | II |
| 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 | Stockdale |
| PREPARER FIRST NAME | Kara |
| PREPARER MIDDLE INITIAL | E |
| PREPARER BUSINESS NAME | Baird Holm LLP |
| PREPARER EMAIL | kstockdale@bairdholm.com |
| BEGIN DATE CONVERTED | 2025-01-06 |
