| CASE NUMBER | I-200-24285-400898 |
| CASE STATUS | Certified |
| RECEIVED DATE | 10/11/2024 |
| DECISION DATE | 10/21/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Medical Laboratory Scientist |
| 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 | Good Samaritan Hospital |
| TRADE NAME DBA | CHI Health Good Samaritan |
| EMPLOYER ADDRESS1 | 10 E. 31st Street |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | Kearney |
| EMPLOYER STATE | NE |
| EMPLOYER POSTAL CODE | 68847 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 13088657100 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 622110 |
| EMPLOYER POC LAST NAME | Falconer |
| EMPLOYER POC FIRST NAME | Tracy |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | Sr. HR Business partner |
| EMPLOYER POC ADDRESS1 | 10 E. 31st Street |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | Kearney |
| EMPLOYER POC STATE | NE |
| EMPLOYER POC POSTAL CODE | 68847 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 13088657093 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | tracy.falconer@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 | 10 E. 31st Street |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Kearney |
| WORKSITE COUNTY | BUFFALO |
| WORKSITE STATE | NE |
| WORKSITE POSTAL CODE | 68847 |
| WAGE RATE OF PAY FROM | $29.92 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Hour |
| PREVAILING WAGE | $29.60 |
| PW UNIT OF PAY | Hour |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | III |
| 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 | 2025-01-06 |
