| LCA CASE NUMBER | I-200-21137-317986 |
| STATUS | Certified |
| LCA CASE SUBMIT | 2021-05-17 |
| DECISION DATE | 2021-05-24 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | Family Medicine Physician |
| SOC CODE | 29-1062.00 |
| SOC TITLE | Family and General Practitioners |
| FULL TIME POSITION | True |
| LCA CASE EMPLOYMENT START DATE | 2021-09-01 |
| END DATE | 2024-08-31 |
| 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 | Missouri Baptist Sullivan Hospital |
| EMPLOYER ADDRESS1 | 751 Sappington Bridge Rd |
| EMPLOYER CITY | Sullivan |
| EMPLOYER STATE | MO |
| EMPLOYER POSTAL CODE | 63080 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 15734684186 |
| NAICS CODE | 622110 |
| EMPLOYER POC LAST NAME | Schwarm |
| EMPLOYER POC FIRST NAME | Tony |
| EMPLOYER POC JOB TITLE | Pesident |
| EMPLOYER POC ADDRESS 1 | 751 Sappington Bridge Road |
| EMPLOYER POC CITY | Sullivan |
| EMPLOYER POC STATE | MO |
| EMPLOYER POC POSTAL CODE | 63080 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 15734684186 |
| EMPLOYER POC EMAIL | TONY.SCHWARM@BJC.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 | True |
| SECONDARY ENTITY BUSINESS NAME | BJC Medical Group Sullivan Clinic |
| WORKSITE ADDRESS1 | 965 Mattox Drive |
| LCA CASE WORKLOC1 CITY | Sullivan |
| WORKSITE COUNTY | CRAWFORD |
| LCA CASE WORKLOC1 STATE | MO |
| WORKSITE POSTAL CODE | 63080 |
| LCA CASE WAGE RATE FROM | 200000 |
| LCA CASE WAGE RATE TO | 270000 |
| LCA CASE WAGE RATE UNIT | Year |
| PREVAILING WAGE | 199160 |
| 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 |
