8/3/2016 page.htmlreport HTML Report (Disclosure) https://olms.dolesa.gov/query/orgReport.do 1/36 A to Z Index | Site Map | FAQs | DOL Forms | About DOL | Contact Us August 3, 2016 DOL Home > OLMS > Public Disclosure Home > Search Criteria > Select Report > Report Printable View U.S. Department of Labor Office of LaborManagement Standards Washington, DC 20210 FORM LM2 LABOR ORGANIZATION ANNUAL REPORT Form Approved Office of Management and Budget No. 12450003 Expires: 08312016 MUST BE USED BY LABOR ORGANIZATIONS WITH $250,000 OR MORE IN TOTAL ANNUAL RECEIPTS AND LABOR ORGANIZATIONS IN TRUSTEESHIP This report is mandatory under P.L. 86257, as amended. Failure to comply may result in criminal prosecution, fines, or civil penalties as provided by 29 U.S.C. 439 or 440. READ THE INSTRUCTIONS CAREFULLY BEFORE PREPARING THIS REPORT. For Official Use Only 1. FILE NUMBER 057419 2. PERIOD COVERED From 01/01/2015 Through 12/31/2015 3. (a) AMENDED Is this an amended report: No (b) HARDSHIP Filed under the hardship procedures: No (c) TERMINAL This is a terminal report: No 4. AFFILIATION OR ORGANIZATION NAME SERVICE EMPLOYEES 5. DESIGNATION (Local, Lodge, etc.) LOCAL UNION 6. DESIGNATION NBR 113 7. UNIT NAME (if any) HEALTHCARE MINNESOTA 8. MAILING ADDRESS (Type or print in capital letters) First Name JAMIE Last Name GULLEY P.O Box Building and Room Number Number and Street 345 RANDOLPH AVE., STE. 100 City ST. PAUL State MN ZIP Code + 4 55102 9. Are your organization's records kept at its mailing address? Yes Each of the undersigned, duly authorized officers of the above labor organization, declares, under penalty of perjury and other applicable penalties of law, that all of the information submitted in this report (including information contained in any accompanying documents) has been examined by the signatory and is, to the best of the undersigned individual's knowledge and belief, true, correct and complete (See Section V on penalties in the instructions.) 70. SIGNED: Jamie T Gulley PRESIDENT 71. SIGNED: Jigme Ugen TREASURER Date: Mar 30, 2016 Telephone Number: 6512948100 Date: Mar 30, 2016 Telephone Number: 6512948104 Form LM2 (Revised 2010)
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8/3/2016 page.htmlreport HTML Report (Disclosure)
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A to Z Index | Site Map | FAQs | DOL Forms | About DOL | Contact Us
August 3, 2016 DOL Home > OLMS > Public Disclosure Home > Search Criteria > Select Report > Report
Printable View
U.S. Department of Labor Office of LaborManagement
Standards Washington, DC 20210
FORM LM2 LABOR ORGANIZATION ANNUALREPORT Form Approved
Office of Management and Budget No. 12450003
Expires: 08312016MUST BE USED BY LABOR ORGANIZATIONS WITH $250,000 OR MORE INTOTAL ANNUAL RECEIPTS AND LABOR ORGANIZATIONS IN TRUSTEESHIP
This report is mandatory under P.L. 86257, as amended. Failure to comply may result in criminal prosecution, fines, or civil penalties as provided by29 U.S.C. 439 or 440.
READ THE INSTRUCTIONS CAREFULLY BEFORE PREPARING THIS REPORT.
For Official UseOnly
1. FILE NUMBER 057419
2. PERIOD COVEREDFrom 01/01/2015Through 12/31/2015
3. (a) AMENDED Is this an amended report: No(b) HARDSHIP Filed under the hardship procedures: No(c) TERMINAL This is a terminal report: No
4. AFFILIATION OR ORGANIZATION NAME SERVICE EMPLOYEES
5. DESIGNATION (Local, Lodge, etc.) LOCAL UNION
6. DESIGNATION NBR 113
7. UNIT NAME (if any) HEALTHCARE MINNESOTA
8. MAILING ADDRESS (Type or print in capital letters)First Name JAMIE
Last Name GULLEY
P.O Box Building and Room Number
Number and Street 345 RANDOLPH AVE., STE. 100
City ST. PAUL
State MN
ZIP Code + 4 55102
9. Are your organization's records kept at its mailing address? Yes
Each of the undersigned, duly authorized officers of the above labor organization, declares, under penalty of perjury and other applicable penalties oflaw, that all of the information submitted in this report (including information contained in any accompanying documents) has been examined by thesignatory and is, to the best of the undersigned individual's knowledge and belief, true, correct and complete (See Section V on penalties in theinstructions.)70. SIGNED: Jamie T Gulley PRESIDENT 71. SIGNED: Jigme Ugen TREASURERDate: Mar 30, 2016 Telephone Number: 6512948100 Date: Mar 30, 2016 Telephone Number: 6512948104
ITEMS 10 THROUGH 21 FILE NUMBER: 05741910. During the reporting period did the labororganization create or participate in the administration ofa trust or a fund or organization, as defined in theinstructions, which provides benefits for members orbeneficiaries?
No
11(a). During the reporting period did the labororganization have a political action committee (PAC)fund?
Yes
11(b). During the reporting period did the labororganization have a subsidiary organization as definedin Section X of these Instructions?
Yes
12. During the reporting period did the labororganization have an audit or review of its books andrecords by an outside accountant or by a parent bodyauditor/representative?
Yes
13. During the reporting period did the labororganization discover any loss or shortage of funds orother assets? (Answer "Yes" even if there has beenrepayment or recovery.)
No
14. What is the maximum amount recoverable under thelabor organization's fidelity bond for a loss caused byany officer, employee or agent of the labor organizationwho handled union funds?
$500,000
15. During the reporting period did the labororganization acquire or dispose of any assets in amanner other than purchase or sale?
No
16. Were any of the labor organization's assets pledgedas security or encumbered in any way at the end of thereporting period?
No
17. Did the labor organization have any contingentliabilities at the end of the reporting period? No
18. During the reporting period did the labororganization have any changes in its constitution orbylaws, other than rates of dues and fees, or inpractices/procedures listed in the instructions?
Yes
19. What is the date of the labor organization's nextregular election of officers? 10/2016
20. How many members did the labor organization have atthe end of the reporting period? 20,752
21. What are the labor organization's rates of dues and fees? Rates of Dues and Fees
Dues/Fees Amount Unit Minimum Maximum(a) RegularDues/Fees N/Aper Month $10 $79
(b) WorkingDues/Fees N/Aper Month $10 $79
(c) Initiation Fees N/Aper NewMember $10 $79
(d) Transfer Fees N/Aper N/A N/A N/A(e) Work Permits N/Aper N/A N/A N/A
Form LM2 (Revised 2010)
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STATEMENT A ASSETS AND LIABILITIES FILE NUMBER: 057419
STATEMENT B RECEIPTS AND DISBURSEMENTS FILE NUMBER: 057419
CASH RECEIPTS SCH AMOUNT36. Dues and Agency Fees $10,184,57737. Per Capita Tax $038. Fees, Fines, Assessments, Work Permits $109,85539. Sale of Supplies $040. Interest $2,88641. Dividends $042. Rents $4,41843. Sale of Investments and Fixed Assets 344. Loans Obtained 945. Repayments of Loans Made 246. On Behalf of Affiliates for Transmittal to Them $162,91447. From Members for Disbursement on TheirBehalf $0
48. Other Receipts 14 $543,37849. TOTAL RECEIPTS $11,008,028
CASH DISBURSEMENTS SCH AMOUNT50. Representational Activities 15 $2,903,84151. Political Activities and Lobbying 16 $189,70652. Contributions, Gifts, and Grants 17 $32,33053. General Overhead 18 $2,011,68354. Union Administration 19 $391,68155. Benefits 20 $1,326,62056. Per Capita Tax $3,181,00557. Strike Benefits $058. Fees, Fines, Assessments, etc. $059. Supplies for Resale $060. Purchase of Investments and Fixed Assets 4 $26,96961. Loans Made 262. Repayment of Loans Obtained 963. To Affiliates of Funds Collected on TheirBehalf $158,703
64. On Behalf of Individual Members $065. Direct Taxes $303,502
66. Subtotal $10,526,04067. Withholding Taxes and Payroll Deductions 67a. Total Withheld $802,278 67b. Less Total Disbursed $802,278 67c. Total Withheld But Not Disbursed 68. TOTAL DISBURSEMENTS $10,526,040
Total of all itemized accounts receivable $0 $0 $0 $0Totals from all other accounts receivable Totals (Total of Column (B) will be automatically entered in Item 23, Column(B)) $0 $0 $0 $0
Form LM2 (Revised 2010)
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SCHEDULE 2 LOANS RECEIVABLE FILE NUMBER: 057419
List below loans to officers, employees, or memberswhich at any time during the reporting period exceeded$250 and list all loans to business enterprises regarless
of amount. (A)
Loans Outstanding at Start of Period
(B)
Loans Made During Period
(C)
Repayments Received DuringPeriod
Cash (D)(1)
Other Than Cash (D)(2)
Loans Outstanding at End of Period
(E)
Total of loans not listed above Total of all lines above $0 $0 $0 $0 $0
Totals will be automatically entered in... Item 24 Column (A)
Item 61 Item 45 Item 69 with Explanation
Item 24 Column (B)
Form LM2 (Revised 2010)
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SCHEDULE 3 SALE OF INVESTMENTS AND FIXED ASSETS FILE NUMBER: 057419
Description (if land or buildings give location) (A)
Cost (B)
Book Value (C)
Gross Sales Price (D)
Amount Received (E)
Total of all lines above $0 $0 $0 $0Less Reinvestments
(The total from Net Sales Line will be automatically entered in Item 43)Net Sales
Form LM2 (Revised 2010)
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SCHEDULE 4 PURCHASE OF INVESTMENTS AND FIXED ASSETS FILE NUMBER: 057419
Description (if land or buildings, give location) (A)
Less Reinvestments $0(The total from Net Purchases Line will be automatically entered in Item 60.)Net Purchases $26,969
Form LM2 (Revised 2010)
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SCHEDULE 5 INVESTMENTS FILE NUMBER: 057419
Description (A)
Amount (B)
Marketable Securities A. Total CostB. Total Book ValueC. List each marketable security which has a book value over $5,000 and exceeds 5% of Line B.
Other Investments D. Total Cost $473,136E. Total Book Value $473,136F. List each other investment which has a book value over $5,000 and exceeds 5% of Line E. Also, list eachsubsidiary for which separate reports are attached.
Real Property: 345 Randolph Ste. 100, St. Paul, MN $473,136G. Total of Lines B and E (Total will be automatically entered in Item 26, Column(B)) $473,136
Form LM2 (Revised 2010)
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SCHEDULE 6 FIXED ASSETS FILE NUMBER: 057419
Description (A)
Cost or Other Basis (B)
Total Depreciation orAmount Expensed
(C)
Book Value (D)
Value (E)
A. Land (give location) $0 $0 $0B. Buildings (give location) $0 $0 $0 $0C. Automobiles and Other VehiclesD. Office Furniture and Equipment $1,042,004 $986,038 $55,966 $55,966E. Other Fixed AssetsF. Totals of Lines A through E (Column(D) Total will beautomatically entered in Item 27, Column(B)) $1,042,004 $986,038 $55,966 $55,966
Form LM2 (Revised 2010)
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SCHEDULE 7 OTHER ASSETS FILE NUMBER: 057419
Description (A)
Book Value (B)
Total (Total will be automatically entered in Item 28, Column(B)) $0
(E)Total for all itemized accounts payable $0 $0 $0 $0Total from all other accounts payable $0 $0 $0 $0Totals (Total for Column(B) will be automatically entered in Item 30,Column(D)) $0 $0 $0 $0
Form LM2 (Revised 2010)
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SCHEDULE 9 LOANS PAYABLE FILE NUMBER: 057419
Source of Loans Payable at Any Time During the Reporting Period
(A)
Loans Owed at Start of Period
(B)
Loans Obtained During Period
(C)
Repayment During Period
Cash (D)(1)
Repayment During Period
Other Than Cash (D)(2)
Loans Owed at End of Period
(E)
Total Loans Payable $0 $0 $0 $0 $0
Totals will be automatically entered in... Item 31 Column (C)
Item 44 Item 62 Item 69 with Explanation
Item 31 Column (D)
Form LM2 (Revised 2010)
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SCHEDULE 10 OTHER LIABILITIES FILE NUMBER: 057419
Description (A)
Amount at End of Period (B)
Total Other Liabilities (Total will be automatically entered in Item 33, Column(D)) $0
Form LM2 (Revised 2010)
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SCHEDULE 11 ALL OFFICERS AND DISBURSEMENTS TO OFFICERS FILE NUMBER: 057419
(A) Name
(B) Title
(C) Status
(D) Gross Salary Disbursements (before any deductions)
(E) Allowances Disbursed
(F) Disbursements
for OfficialBusiness
(G) Other
Disbursements notreported in
(D) through (F)
(H) TOTAL
A B C
ALTHOFF , JOYCE DELEGATEC
$2,995 $0 $545 $0 $3,540
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
ANDERSON , MELVIN DELEGATEP
$54,019 $0 $2,452 $0 $56,471
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
ASMUS , ELIZABETH EXECUTIVE VICE PRESIDENTC
$88,940 $0 $559 $0 $89,499
ISchedule 15 RepresentationalActivities
100 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 0 %
A B C
BACK , KURT TRUSTEEC
$4,019 $0 $1,242 $0 $5,261
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
BALE , MARY DELEGATEC
$2,988 $0 $385 $0 $3,373
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
BARNES , JOSCELYN DELEGATEC
$3,400 $0 $433 $0 $3,833
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
BERNINI , BRIANNE DELEGATEN
$3,580 $0 $369 $0 $3,949
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
BLUHM , REBECCA DELEGATEC
$54 $0 $656 $0 $710
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
BURMAN , RENEE ASSISTANT GUARDC
$2,094 $0 $385 $0 $2,479
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
BUTTER , CHARLIE DELEGATEC
$5,952 $0 $2,530 $0 $8,482
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
BYERS , TALLAYA DELEGATEN
$285 $0 $8 $0 $293
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
CARLSON , LYNN DELEGATEC
$5,077 $0 $683 $0 $5,760
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
CROMEDY , BENNIE DELEGATEC
$2,410 $0 $499 $0 $2,909
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
CRYAN , PHILLIP EXECUTIVE VICE PRESIDENTC
$85,685 $0 $2,352 $0 $88,037
Schedule 15 Representational 95 %
Schedule 16 Political Activities 2 %
Schedule 17 Contributions 0 %
Schedule 18 General Overhead 2 %
Schedule 19 Administration 1 %
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I Activities and Lobbying
A B C
DONAZAL , CLEVELAND DELEGATEN
$3,879 $0 $720 $0 $4,599
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
DUFFEE , LOUISE DELEGATEN
$430 $0 $25 $0 $455
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
EDWARDS , DIANNE EXECUTIVE VICE PRESIDENTC
$70,271 $0 $0 $0 $70,271
ISchedule 15 RepresentationalActivities
90 %Schedule 16 Political Activitiesand Lobbying
10 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 0 %
A B C
ELRITE , KATHRYN DELEGATEC
$1,926 $0 $481 $0 $2,407
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
FADERA , YANKUBA DELEGATEC
$3,233 $0 $397 $0 $3,630
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
FREEMAN , MARK DELEGATEC
$2,553 $0 $385 $0 $2,938
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
GRAY , DARLENE DELEGATEC
$836 $0 $0 $0 $836
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
GULLEY , JAMIE PRESIDENTC
$117,532 $0 $1,419 $0 $118,951
ISchedule 15 RepresentationalActivities
84 %Schedule 16 Political Activitiesand Lobbying
1 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 5 % Schedule 19 Administration 10 %
A B C
HALL , FRANCIS DELEGATEC
$470 $0 $2,930 $0 $3,400
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
HANSON , CRISSY DELEGATEC
$2,391 $0 $791 $0 $3,182
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
HOLLMAN , IRENE GUARDC
$1,391 $0 $489 $0 $1,880
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
HOWZE , DEBRA DELEGATEC
$2,734 $0 $0 $0 $2,734
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
HUGHES , LATANYA DELEGATEC
$765 $0 $0 $0 $765
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
JACKSON , NATALIE DELEGATEC
$1,382 $0 $159 $0 $1,541
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
JOHNSON , SHAQUONICA VICE PRESIDENTC
$3,024 $0 $0 $0 $3,024
Schedule 15 Schedule 16
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I RepresentationalActivities
0 % Political Activitiesand Lobbying
0 % Schedule 17 Contributions
0 % Schedule 18 General Overhead
0 % Schedule 19 Administration
100 %
A B C
KOSKI , SANDY DELEGATEC
$3,738 $0 $385 $0 $4,123
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
LEMIRE , SONJA VICE PRESIDENTC
$2,109 $0 $732 $0 $2,841
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
LYNCH , KATHERINE VICE PRESIDENTC
$2,323 $0 $508 $0 $2,831
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
MARTIN , ELIZABETH UNDER 30 DELEGATEP
$66,624 $0 $505 $0 $67,129
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
MARTIN , EMILY TRUSTEEC
$1,616 $0 $514 $0 $2,130
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
MATTHEWS , RITA DELEGATEC
$2,292 $0 $385 $0 $2,677
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
MAXON , MAXINE DELEGATEC
$3,320 $0 $429 $0 $3,749
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
MEYER , KATHLENE DELEGATEC
$1,088 $0 $457 $0 $1,545
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
MINTEY , DAN TRUSTEEC
$7,905 $0 $2,366 $0 $10,271
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
MOUA , CHU EX OFFICIOP
$300 $0 $0 $300
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
NORDBY , MELODY DELEGATEC
$2,699 $0 $1,979 $0 $4,678
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
PILLE , KIA DELEGATEN
$1,260 $0 $175 $0 $1,435
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
PHILLIPS , COURTNEY DELEGATEN
$54 $0 $851 $0 $905
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
RAMNAUTH , KAMALA DLEGATEC
$2,728 $0 $531 $0 $3,259
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
SARRO , JEFF DELEGATEC
$4,846 $0 $235 $0 $5,081
Schedule 15 Schedule 16
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I RepresentationalActivities
0 % Political Activitiesand Lobbying
0 % Schedule 17 Contributions
0 % Schedule 18 General Overhead
0 % Schedule 19 Administration
100 %
A B C
SCHINDLER , LARRY DELEGATEC
$5,036 $0 $300 $0 $5,336
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
SMITH , JOHNNIE DELEGATEC
$5,068 $0 $1,185 $0 $6,253
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
SPIKA , SUMER VICE PRESIDENTC
$784 $0 $86 $0 $870
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
STANKOVICH , TRACY TRUSTEEC
$4,099 $0 $307 $0 $4,406
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
TOMFOHRDE , MINDA DELEGATEC
$1,097 $0 $788 $0 $1,885
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
UGEN , JIGME EXECUTIVE VICE PRESIDENTC
$96,475 $0 $321 $0 $96,796
ISchedule 15 RepresentationalActivities
73 %Schedule 16 Political Activitiesand Lobbying
3 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 24 %
A B C
URMAN , ELSIE RETIREE DELEGATEC
$503 $0 $509 $0 $1,012
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
VANDENBURGH , COREY DELEGATEC
$654 $0 $237 $0 $891
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
WEED , LISA EXECUTIVE VICE PRESIDENTC
$92,115 $0 $465 $0 $92,580
ISchedule 15 RepresentationalActivities
100 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 0 %
A B C
WILCOX , KENT VICE PRESIDENTC
$2,618 $0 $385 $0 $3,003
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
WIRPEL , JAN DELEGATEN
$524 $0 $0 $0 $524
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
WOODARD , EMMA DELEGATEC
$746 $0 $205 $0 $951
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
YOST , JUSTIN UNDER 30 DELEGATEC
$833 $0 $838 $0 $1,671
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
A B C
ZAHN , MARTY DELEGATEC
$2,476 $0 $1,098 $0 $3,574
ISchedule 15 RepresentationalActivities
0 %Schedule 16 Political Activitiesand Lobbying
0 % Schedule 17 Contributions 0 % Schedule 18
General Overhead 0 % Schedule 19 Administration 100 %
Members (Total of all lines above) 20,752 Agency Fee Payers* 107Total Members/Fee Payers 20,859 *Agency Fee Payers are not considered members of the labor organization.
Regular Members 15,338 YesLow Income Members 5,414 Yes
Form LM2 (Revised 2010)
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DETAILED SUMMARY PAGE SCHEDULES 14 THROUGH 19 FILE NUMBER: 057419
SCHEDULE 14 OTHER RECEIPTS1. Named Payer Itemized Receipts $494,2282. Named Payer Nonitemized Receipts $21,8883. All Other Receipts $27,2624. Total Receipts $543,378
SCHEDULE 17 CONTRIBUTIONS, GIFTS & GRANTS1. Named Payee Itemized Disbursements $11,0002. Named Payee Nonitemized Disbursements $03. To Officers $04. To Employees $05. All Other Disbursements $21,3306. Total Disbursements $32,330
SCHEDULE 15 REPRESENTATIONAL ACTIVITIES1. Named Payee Itemized Disbursements $524,5872. Named Payee Nonitemized Disbursements $128,2183. To Officers $499,5384. To Employees $1,532,7375. All Other Disbursements $218,7616. Total Disbursements $2,903,841
SCHEDULE 18 GENERAL OVERHEAD1. Named Payee Itemized Disbursements $720,5142. Named Payee Nonitemized Disbursements $279,4613. To Officers $7,7094. To Employees $1,001,1195. All Other Disbursements $2,8806. Total Disbursements $2,011,683
SCHEDULE 16 POLITICAL ACTIVITIES AND LOBBYING1. Named Payee Itemized Disbursements $5,7292. Named Payee Nonitemized Disbursements $65,1023. To Officers $12,8824. To Employees $104,1355. All Other Disbursements $1,8586. Total Disbursement $189,706
SCHEDULE 19 UNION ADMINISTRATION1. Named Payee Itemized Disbursements $5,7542. Named Payee Nonitemized Disbursements $4503. To Officers $307,7874. To Employees $64,5615. All Other Disbursements $13,1296. Total Disbursements $391,681
Form LM2 (Revised 2010)
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SCHEDULE 14 OTHER RECEIPTS FILE NUMBER: 057419
Name and Address (A)
Cook County North Shore Care Center
515 5th Ave WGrand MaraisMN55604
Type or Classification (B)
Medical Center
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer $16,756Total NonItemized Transactions with this Payee/Payer Total of All Transactions with this Payee/Payer for This Schedule $16,756
Dues Prior to Association 04/09/2015 $16,756
Name and Address (A)
North Memorial Medical Center
3300 Oakdale Ave NRobbinsdaleMN55422
Type or Classification (B)
Medical Center
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer $61,251Total NonItemized Transactions with this Payee/Payer Total of All Transactions with this Payee/Payer for This Schedule $61,251
Pension Contributions Error 02/06/2015 $61,251
Name and Address (A)
Service Employees International Union
1800 Massachusetts Ave NWWashingtonDC20036
Type or Classification (B)
International Union
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer $416,221Total NonItemized Transactions with this Payee/Payer $21,888Total of All Transactions with this Payee/Payer for This Schedule $438,109
Field Test of Beta Release COPE APP & CC 01/09/2015 $28,464Memorandum of Agreement Balance 01/09/2015 $85,000Per Capita Rebates 03/13/2015 $15,299Per Capita Rebates 04/28/2015 $12,436Per Capita Rebates 05/11/2015 $15,439Per Capita Rebates 06/05/2015 $15,000Per Capita Rebates 07/03/2015 $14,065Structural Relief 08/07/2015 $15,000Per Capita Rebates 09/22/2015 $20,564Per Capita Rebates 10/02/2015 $24,107Per Capita Rebates 11/06/2015 $21,208Transformation Center Pilot Project 11/20/2015 $125,000Per Capita Rebates 12/11/2015 $24,639
Total Itemized Transactions with this Payee/Payer $70,000Total NonItemized Transactions with this Payee/Payer Total of All Transactions with this Payee/Payer for This Schedule $70,000
Postage Meter 02/10/2015 $10,000Postage Meter 05/21/2015 $10,000Postage Meter 07/07/2015 $10,000Postage Meter 08/26/2015 $10,000Postage Meter 10/26/2015 $10,000Postage Meter 11/30/2015 $10,000Postage Meter 12/28/2015 $10,000
Name and Address (A)
Cummins & Cummins
920 Second Avenue SouthMinneapolisMN55402
Type or Classification (B)
Law Firm
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer $377,440Total NonItemized Transactions with this Payee/Payer Total of All Transactions with this Payee/Payer for This Schedule $377,440
Total Itemized Transactions with this Payee/Payer Total NonItemized Transactions with this Payee/Payer $13,332Total of All Transactions with this Payee/Payer for This Schedule $13,332
Name and Address (A)
Gil Vernon
808 Carmichael Rd. #115HudsonWI54016
Type or Classification (B)
Arbitrator
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer Total NonItemized Transactions with this Payee/Payer $9,000Total of All Transactions with this Payee/Payer for This Schedule $9,000
Name and Address (A)
Impact Printing
1067 Rice StreetSt. PaulMN55117
Type or Classification (B)
Commerical Printing Services
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer Total NonItemized Transactions with this Payee/Payer $10,040Total of All Transactions with this Payee/Payer for This Schedule $10,040
Name and Address (A)
InPulse CPR
11035 Hearth Rd.Spring HillFL34608
Type or Classification (B)
CPR Training
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer Total NonItemized Transactions with this Payee/Payer $9,350Total of All Transactions with this Payee/Payer for This Schedule $9,350
Name and Address (A)
Lone Oak
3177 Dodd Rd.EaganMN55121
Type or Classification (B)
Mailing House
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer $5,194Total NonItemized Transactions with this Payee/Payer $4,184Total of All Transactions with this Payee/Payer for This Schedule $9,378
Printing Expense 02/10/2015 $5,194
Name and Address
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(A)Orbitz
500 W. Madison, Ste. 1000ChicagoIL60661
Type or Classification (B)
Travel Agent
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer Total NonItemized Transactions with this Payee/Payer $6,995Total of All Transactions with this Payee/Payer for This Schedule $6,995
Name and Address (A)
Outfront Media33074
NewarkNJ07188
Type or Classification (B)
Media Services
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer $18,000Total NonItemized Transactions with this Payee/Payer $5,405Total of All Transactions with this Payee/Payer for This Schedule $23,405
Media for Campaigns 02/24/2015 $7,500Media for Campaigns 02/24/2015 $10,500
Name and Address (A)
Ramada
1330 Industrial BlvdMinneapolisMN55413
Type or Classification (B)
Hotel
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer $10,992Total NonItemized Transactions with this Payee/Payer $37,573Total of All Transactions with this Payee/Payer for This Schedule $48,565
Hotel Expenses 12/14/2015 $10,992
Name and Address (A)
Sheraton
2901 Chicago Avenue SouthMinneapolisMN55407
Type or Classification (B)
Hotel
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer $8,130Total NonItemized Transactions with this Payee/Payer Total of All Transactions with this Payee/Payer for This Schedule $8,130
Meals 12/28/2015 $8,130
Name and Address (A)
Skinners Pub
919 RandolphSt. PaulMN55102
Type or Classification (B)
Restaurant
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer Total NonItemized Transactions with this Payee/Payer $8,011Total of All Transactions with this Payee/Payer for This Schedule $8,011
Name and Address (A)
St. Paul Saints
1771 Energy Park DriveSt. PaulMN55108
Type or Classification (B)
Baseball Team
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer $5,266Total NonItemized Transactions with this Payee/Payer Total of All Transactions with this Payee/Payer for This Schedule $5,266
Saints Game 02/17/2015 $5,266
Name and Address (A)
Telephone Town Hall Meeting, Inc.
958 Coneflower Dr.GoldenCO80401
Type or Classification (B)
Telephone Town Hall Service
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer $5,565Total NonItemized Transactions with this Payee/Payer $13,340Total of All Transactions with this Payee/Payer for This Schedule $18,905
Meeting Hall Organizing 03/17/2015 $5,565
Name and Address (A)
Titan Outdoor, LLC5179
New YorkNY10087
Type or Classification (B)
Advertising Agency
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer $24,000Total NonItemized Transactions with this Payee/Payer Total of All Transactions with this Payee/Payer for This Schedule $24,000
Billboard 02/24/2015 $13,244Billboard 03/23/2015 $10,756
Name and Address (A)
Union Communications
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165 Conduit StreetAnnapolisMD21401
Type or Classification (B)
Newsletter Distributor
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer Total NonItemized Transactions with this Payee/Payer $5,534Total of All Transactions with this Payee/Payer for This Schedule $5,534
Name and Address (A)
Union House
26796 Felton AvenueWyomingMN55092
Type or Classification (B)
Apparel Store
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer Total NonItemized Transactions with this Payee/Payer $5,454Total of All Transactions with this Payee/Payer for This Schedule $5,454
Form LM2 (Revised 2010)
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SCHEDULE 16 POLITICAL ACTIVITIES AND LOBBYING FILE NUMBER 057419
Name and Address (A)
Frenette Legislative Advisors
1734 Blair AvenueSt. PaulMN55104
Type or Classification (B)
Lobbying Sevices
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer Total NonItemized Transactions with this Payee/Payer $26,500Total of All Transactions with this Payee/Payer for This Schedule $26,500
Name and Address (A)
SEIU Local 113 PAC Acct
345 Randolph Ave Ste. 100St. PaulMN55102
Type or Classification (B)
PAC Affiliate
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer $5,729Total NonItemized Transactions with this Payee/Payer $30,602Total of All Transactions with this Payee/Payer for This Schedule $36,331
Political Advocacy 05/29/2015 $5,729
Name and Address (A)
The Lehman Group
4525 Douglas AvenueGolden ValleyMN55416
Type or Classification (B)
Lobbying Sevices
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer Total NonItemized Transactions with this Payee/Payer $8,000Total of All Transactions with this Payee/Payer for This Schedule $8,000
Total Itemized Transactions with this Payee/Payer $5,000Total NonItemized Transactions with this Payee/Payer Total of All Transactions with this Payee/Payer for This Schedule $5,000
Donation 03/05/2015 $5,000
Name and Address (A)
Healthcare Career Advancement Program2565
New YorkNY10108
Type or Classification (B)
National Labor/Management Organization
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer $6,000Total NonItemized Transactions with this Payee/Payer Total of All Transactions with this Payee/Payer for This Schedule $6,000
Membership Dues 03/23/2015 $6,000
Form LM2 (Revised 2010)
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SCHEDULE 18 GENERAL OVERHEAD FILE NUMBER: 057419
Name and Address (A)
AT&T Mobility6463
Carol StreamIL60197
Type or Classification (B)
Telecomunications Company
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer Total NonItemized Transactions with this Payee/Payer $31,915Total of All Transactions with this Payee/Payer for This Schedule $31,915
Name and Address (A)
Bellows Associates, P.A.
7890 Peters Rd. Ste G102PlantationFL33324
Type or Classification (B)
CPA Firm
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer $12,411Total NonItemized Transactions with this Payee/Payer Total of All Transactions with this Payee/Payer for This Schedule $12,411
Audit services 06/30/2015 $12,411
Name and Address (A)
Corporate Technologies LLC1450
MinneapolisMN55485
Type or Classification (B)
IT Support Services
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer Total NonItemized Transactions with this Payee/Payer $35,115Total of All Transactions with this Payee/Payer for This Schedule $35,115
Name and Address (A)
Creative Resources
1208 5th Street SouthHopkinsMN55343
Type or Classification (B)
Merchandise Company
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer $10,411Total NonItemized Transactions with this Payee/Payer $125Total of All Transactions with this Payee/Payer for This Schedule $10,536
Total Itemized Transactions with this Payee/Payer $34,900Total NonItemized Transactions with this Payee/Payer $8,115Total of All Transactions with this Payee/Payer for This Schedule $43,015
Printing of Authorization Forms 07/31/2015 $9,525Printing Expense 12/07/2015 $25,375
Name and Address (A)
Image Pointe657
WaterlooIA50704
Type or Classification (B)
TShirt and Apparel Store
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer $21,367Total NonItemized Transactions with this Payee/Payer $18,574Total of All Transactions with this Payee/Payer for This Schedule $39,941
Member Activities Supplies 03/17/2015 $15,307Member Activities Supplies 09/14/2015 $6,060
Name and Address (A)
Innovative Office Solutions270107
MinneapolisMN55427
Type or Classification (B)
Office Supply Store
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer Total NonItemized Transactions with this Payee/Payer $24,232Total of All Transactions with this Payee/Payer for This Schedule $24,232
Name and Address (A)
Integra Telecom2966
MilwaukeeWI53201
Type or Classification (B)
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer $6,156Total NonItemized Transactions with this Payee/Payer $18,159Total of All Transactions with this Payee/Payer for This Schedule $24,315
Telephone Expense 01/12/2015 $6,156
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Telecommunications ServicesName and Address
(A)Konica Minolta Premier Finance790448
St. LouisMO63179
Type or Classification (B)
Equipment Leasing
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer Total NonItemized Transactions with this Payee/Payer $20,543Total of All Transactions with this Payee/Payer for This Schedule $20,543
Name and Address (A)
Level 3 Communications910182
DenverCO80291
Type or Classification (B)
Telecommunications Services
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer Total NonItemized Transactions with this Payee/Payer $12,766Total of All Transactions with this Payee/Payer for This Schedule $12,766
Name and Address (A)
Marco Copiers1450
MinneapolisMN55485
Type or Classification (B)
Equipment Leasing
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer Total NonItemized Transactions with this Payee/Payer $19,601Total of All Transactions with this Payee/Payer for This Schedule $19,601
Name and Address (A)
Minuteman Press
2101 Hennepin Ave SouthMinneapolisMN55405
Type or Classification (B)
Commercial Printing Services
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer $7,294Total NonItemized Transactions with this Payee/Payer $1,893Total of All Transactions with this Payee/Payer for This Schedule $9,187
Printing Expenses 07/13/2015 $7,294
Name and Address (A)
North Memorial Medical Center
3300 Oakdale Ave NorthRobbinsdaleMN55422
Type or Classification (B)
Medical Center
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer $61,251Total NonItemized Transactions with this Payee/Payer Total of All Transactions with this Payee/Payer for This Schedule $61,251
Pension Contributions Error 02/24/2015 $61,251
Name and Address (A)
Rochester Town Offices
209 Woodlake Drive SERochesterMN55904
Type or Classification (B)
Office Rental
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer Total NonItemized Transactions with this Payee/Payer $32,250Total of All Transactions with this Payee/Payer for This Schedule $32,250
Name and Address (A)
Seven Corners Printing Company
1099 Snelling Ave. NorthSt. PaulMN55108
Type or Classification (B)
Commercial Printing Services
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer $115,541Total NonItemized Transactions with this Payee/Payer $9,904Total of All Transactions with this Payee/Payer for This Schedule $125,445
Total Itemized Transactions with this Payee/Payer $412,000Total NonItemized Transactions with this Payee/Payer Total of All Transactions with this Payee/Payer for This Schedule $412,000
Total Itemized Transactions with this Payee/Payer $32,010Total NonItemized Transactions with this Payee/Payer $46,269Total of All Transactions with this Payee/Payer for This Schedule $78,279
Total Itemized Transactions with this Payee/Payer $7,173Total NonItemized Transactions with this Payee/Payer Total of All Transactions with this Payee/Payer for This Schedule $7,173
Office Equipment Insurance 11/23/2015 $7,173
Form LM2 (Revised 2010)
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SCHEDULE 19 UNION ADMINISTRATION FILE NUMBER: 057419
Name and Address (A)
Hillcrest Golf Club
2200 East Larpenteur AvenueSt. PaulMN55109
Type or Classification (B)
Golf Club
Purpose (C)
Date (D)
Amount (E)
Total Itemized Transactions with this Payee/Payer $5,754Total NonItemized Transactions with this Payee/Payer $450Total of All Transactions with this Payee/Payer for This Schedule $6,204
Recognition Dinner 05/26/2015 $5,754
Form LM2 (Revised 2010)
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SCHEDULE 20 BENEFITS FILE NUMBER: 057419
Description (A)
To Whom Paid (B)
Amount (C)
Total of all lines above (Total will be automatically entered in Item 55.) $1,326,620
Dental Insurance Delta Dental $88Health Insurance Health Partners $528,420Life Insurance Met Life $24,970Pension SEIU Affiliates & Officers $568,775Pension Twin City Workers Pension Fund $51,056HSA Funding Associated Bank $108,800Workmens Compensation Amtrust North America $15,285Benefits Administration Freedom Services Inc. $953Pension SEIU Fund Office $1,395Workmens Compensation Western Insurance Agency $26,878
Form LM2 (Revised 2010)
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Frequently Asked Questions | Freedom of Information Act | Privacy & Security Statement | Disclaimers | Customer Survey | Important Web Site Notices
U.S. Department of Labor | Frances Perkins Building, 200 Constitution Ave., NW, Washington, DC 20210www.dol.gov | Telephone: 18664USADOL (18664872365) | TTY: 187748895627 | Contact Us
69. ADDITIONAL INFORMATION SUMMARY FILE NUMBER: 057419
Question 11(a):
Question 11(a): : : Name of PAC: SEIU Healthcare Minnesota Political Action Committee. Report filed: Campaign finance report of receipts andexpenditures. Government Agency: Filed with the Campaign Finance and Public Disclosure Board. Purpose: The PAC is a separatesegregated fund established to support candidates for state and local offices who promote the interests of organized labor.
Question 11(b):
Question 11(b): : : Name of Subsidiary: Service Employees International Union Local 113 Building Corporation. Address: 345 Randolph, Suite100, St. Paul, MN 55102 Fiscal Year End: December 31, 2015. Relationship: The Union is the sole investor and owner of the BuildingCorporation in which the Union operates and conducts union business. Option #2 Recognition: The net assets of the Building Corporation arereported as an investment on Line 26 and on
Schedule 13, Row1:::A regular member is one who is active at a facility within the jurisdiction of the Local. Active members pay full dues andhave full voting rights.
Schedule 13, Row1:::
Schedule 13, Row2:::A low income payee is one who is active at a facility within the jurisdiction of the Local. Active members pay full dues andhave full voting rightsForm LM2 (Revised 2010)