| LCA CASE NUMBER | I-200-21113-254445 |
| STATUS | Certified |
| LCA CASE SUBMIT | 2021-04-23 |
| DECISION DATE | 2021-04-30 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | Internal Medicine Physician |
| SOC CODE | 29-1063.00 |
| SOC TITLE | Internists, General |
| FULL TIME POSITION | True |
| LCA CASE EMPLOYMENT START DATE | 2021-10-01 |
| END DATE | 2024-09-30 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 1 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| LCA CASE EMPLOYER NAME | Crawford Hospital District |
| TRADE NAME DBA | Crawford Memorial Hospital |
| EMPLOYER ADDRESS1 | 1000 N Allen St |
| EMPLOYER CITY | Robinson |
| EMPLOYER STATE | IL |
| EMPLOYER POSTAL CODE | 62454 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 16185443131 |
| NAICS CODE | 622110 |
| EMPLOYER POC LAST NAME | Florkowski |
| EMPLOYER POC FIRST NAME | Doug |
| EMPLOYER POC JOB TITLE | Chief Executive Officer |
| EMPLOYER POC ADDRESS 1 | 1000 North Allen Street |
| EMPLOYER POC CITY | Robinson |
| EMPLOYER POC STATE | IL |
| EMPLOYER POC POSTAL CODE | 62454 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 16185443131 |
| EMPLOYER POC EMAIL | doug.florkowski@crawfordmh.org |
| AGENT REPRESENTING EMPLOYER | True |
| 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 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 | False |
| WORKSITE ADDRESS1 | 1101 North Allen Street |
| LCA CASE WORKLOC1 CITY | Robinson |
| WORKSITE COUNTY | CRAWFORD |
| LCA CASE WORKLOC1 STATE | IL |
| WORKSITE POSTAL CODE | 62454 |
| LCA CASE WAGE RATE FROM | 185000 |
| LCA CASE WAGE RATE TO | 275000 |
| LCA CASE WAGE RATE UNIT | Year |
| PREVAILING WAGE | 175594 |
| PW UNIT OF PAY | Year |
| PW WAGE LEVEL | II |
| PW OES YEAR | 7/1/2020 - 6/30/2021 |
| TOTAL WORKSITE LOCATIONS | 1 |
| AGREE TO LC STATEMENT | True |
| H1B DEPENDENT | False |
| WILLFUL VIOLATOR | False |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | Bell |
| PREPARER FIRST NAME | Jeffrey |
| PREPARER MIDDLE INITIAL | S |
| PREPARER BUSINESS NAME | Polsinelli PC |
| PREPARER EMAIL | jbell@polsinelli.com |
