| LCA CASE NUMBER | I-200-21145-341471 |
| STATUS | Certified |
| LCA CASE SUBMIT | 2021-05-25 |
| DECISION DATE | 2021-06-02 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | Family Medicine Physician |
| SOC CODE | 29-1069.00 |
| SOC TITLE | Physicians and Surgeons, All Other |
| FULL TIME POSITION | True |
| LCA CASE EMPLOYMENT START DATE | 2021-07-11 |
| END DATE | 2024-07-10 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 1 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| LCA CASE EMPLOYER NAME | Integrated Health Systems, Inc. |
| TRADE NAME DBA | d/b/a Three Rivers Health |
| EMPLOYER ADDRESS1 | 701 South Health Parkway |
| EMPLOYER CITY | Three Rivers |
| EMPLOYER STATE | MI |
| EMPLOYER POSTAL CODE | 49093 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 12692739601 |
| NAICS CODE | 622110 |
| EMPLOYER POC LAST NAME | Shannon |
| EMPLOYER POC FIRST NAME | David |
| EMPLOYER POC MIDDLE NAME | A. |
| EMPLOYER POC JOB TITLE | Chief Executive Officer (CEO) |
| EMPLOYER POC ADDRESS 1 | 701 South Health Parkway |
| EMPLOYER POC CITY | Three Rivers |
| EMPLOYER POC STATE | MI |
| EMPLOYER POC POSTAL CODE | 49093 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 12692739601 |
| EMPLOYER POC EMAIL | dshannon@trhealth.org |
| AGENT REPRESENTING EMPLOYER | True |
| AGENT ATTORNEY LAST NAME | Koryto |
| AGENT ATTORNEY FIRST NAME | John |
| AGENT ATTORNEY MIDDLE NAME | Francis |
| AGENT ATTORNEY ADDRESS1 | 100 West Michigan Avenue |
| AGENT ATTORNEY ADDRESS2 | Suite 200 |
| AGENT ATTORNEY CITY | Kalamazoo |
| AGENT ATTORNEY STATE | MI |
| AGENT ATTORNEY POSTAL CODE | 49007 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PHONE | 12692262979 |
| AGENT ATTORNEY EMAIL ADDRESS | korytoj@millerjohnson.com |
|
| LAWFIRM NAME BUSINESS NAME | Miller Johnson |
| STATE OF HIGHEST COURT | MI |
| NAME OF HIGHEST STATE COURT | Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | False |
| WORKSITE ADDRESS1 | Three Rivers Family Health |
| WORKSITE ADDRESS2 | 721 6th Avenue |
| LCA CASE WORKLOC1 CITY | Three Rivers |
| WORKSITE COUNTY | ST JOSEPH |
| LCA CASE WORKLOC1 STATE | MI |
| WORKSITE POSTAL CODE | 49093 |
| LCA CASE WAGE RATE FROM | 208000 |
| LCA CASE WAGE RATE TO | 247000 |
| LCA CASE WAGE RATE UNIT | Year |
| PREVAILING WAGE | 208000 |
| PW UNIT OF PAY | Year |
| 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 Employment |
| PREPARER BUSINESS NAME | Not Applicable |
