| LCA CASE NUMBER | I-200-21204-480752 |
| STATUS | Certified |
| LCA CASE SUBMIT | 2021-07-23 |
| DECISION DATE | 2021-07-30 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | Physician Assistant |
| SOC CODE | 29-1071.00 |
| SOC TITLE | Physician Assistants |
| FULL TIME POSITION | True |
| LCA CASE EMPLOYMENT START DATE | 2021-09-17 |
| END DATE | 2024-09-16 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 1 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| LCA CASE EMPLOYER NAME | Hartford Hospital |
| EMPLOYER ADDRESS1 | 80 Seymour Street |
| EMPLOYER CITY | Hartford |
| EMPLOYER STATE | CT |
| EMPLOYER POSTAL CODE | 6102 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 18609722111 |
| NAICS CODE | 622110 |
| EMPLOYER POC LAST NAME | Dusza |
| EMPLOYER POC FIRST NAME | Molly |
| EMPLOYER POC JOB TITLE | Human Resources Generalist |
| EMPLOYER POC ADDRESS1 | 195 Retreat Avenue |
| EMPLOYER POC CITY | Hartford |
| EMPLOYER POC STATE | CT |
| EMPLOYER POC POSTAL CODE | 6106 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 18609722111 |
| EMPLOYER POC EMAIL | Molly.Dusza@hhchealth.org |
| AGENT REPRESENTING EMPLOYER | True |
| AGENT ATTORNEY LAST NAME | Fillenwarth |
| AGENT ATTORNEY FIRST NAME | Charlotte |
| AGENT ATTORNEY MIDDLE NAME | Marie |
| AGENT ATTORNEY ADDRESS1 | 500 North Meridian Street |
| AGENT ATTORNEY ADDRESS2 | Suite 400 |
| AGENT ATTORNEY CITY | Indianapolis |
| AGENT ATTORNEY STATE | IN |
| AGENT ATTORNEY POSTAL CODE | 46204 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PHONE | 13179771476 |
| AGENT ATTORNEY EMAIL ADDRESS | cfillenwarth@hallrender.com |
| LAWFIRM NAME BUSINESS NAME | Hall, Render, Killian, Heath & Lyman, P.C. |
| STATE OF HIGHEST COURT | IN |
|
| NAME OF HIGHEST STATE COURT | Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | False |
| WORKSITE ADDRESS1 | 80 Seymour Street |
| LCA CASE WORKLOC1 CITY | Hartford |
| WORKSITE COUNTY | HARTFORD CITY |
| LCA CASE WORKLOC1 STATE | CT |
| WORKSITE POSTAL CODE | 6102 |
| LCA CASE WAGE RATE FROM | 109778.16 |
| LCA CASE WAGE RATE UNIT | Year |
| PREVAILING WAGE | 109491 |
| PW UNIT OF PAY | Year |
| PW WAGE LEVEL | I |
| PW OES YEAR | 7/1/2021 - 6/30/2022 |
| TOTAL WORKSITE LOCATIONS | 2 |
| AGREE TO LC STATEMENT | True |
| H-1B DEPENDENT | False |
| WILLFUL VIOLATOR | False |
| PUBLIC DISCLOSURE | Disclose Business |
