IMPORTANT: This report is mandatory under P.L. 86-257, as
amended. Failure to comply may result in criminal prosecution,
fines, or civil penalties as provided by 29 U.S.C. 439 or 440.
Required of persons, including Labor Relations Consultants and
Other Individuals and Organizations, under Section 203(b) of
the
Labor-Management Reporting and Disclosure Act of 1959, as
amended (LMRDA).
Office of Labor-Management Standards
U.S. Department of Labor
For Official Use Only
E
OLMS
Read the instructions carefully before completing this report.
1.a. File Number: C-67190
Amended:
2.
Name and mailing address (including Zip Code):
Name:KIRSTEN JOHNSON MOORE
Title:Consultant
Organization:KJM Consultants
P.O. Box., Bldg., Room No., if any:#6309
Street:750 Egret Circle
City:Delrary BeachState:FL
ZIP code:19003
3.
Other address where records necessary to
verify this report are kept:
Name:
Title:
Organization:
P.O. Box., Bldg., Room No., if any:
Street:
City:State:
ZIP code:
4.
Date fiscal year ends:Dec /23
5.
Type of person
a.
Individual b.
Partnership
c.
X
Corporation C d.
Other
Specify:
Nature of Agreement or Arrangement
6.
Full name and address of employer with whom made (include ZIP Code):
Name:Kris Lukish
Organization:Johns Hopkins Hospital
Trade Name, if any:
P.O. Box., Bldg., Room No., if any:
Street:600 North Wolfe Stree
City:BaltimoreState:MD
ZIP code:21287
7.
Date entered into02/21/2023
8.
Name of person(s) through whom made:
Name:Kris Lukish
Signature and Verification
Each
of the undersigned declares, under penalty
of
perjury
and
other
applicable penalties of law, that all of the
information
submitted in this report (including the information
contained in
any accompanying documents) has been examined by
the
signatory
and
is, to the best of the undersigned's
knowledge
and
belief,
true, correct, and complete. (See Section
VII on
penalties in the
instructions.)
13.
SIGNED:
Kirsten Johnson-Moore
Title:
PRESIDENT
Date:
Mar 23, 2023
Telephone Number:
610-420-0819
14.
SIGNED:
Kirsten Johnson-Moore
Title:
TREASURER
Date:
Mar 23, 2023
Telephone Number:
610-420-0819
Form LM-20 (2003)
9.
Check the appropriate box(es) to indicate
whether an object
of the activities undertaken is directly
or
indirectly:
a.
X
To persuade employees to exercise or not to
exercise, or persuade employees as to the manner of
exercising, the right to organize and bargain collectively
through representatives of their own choosing.
b.
To supply an employer with information
concerning the activities of employees or a labor
organization in connection with a labor dispute involving
such employer, except information for use solely in
conjunction with an administrative or arbitral proceeding
or
a criminal or civil judicial proceeding.
10.
Terms and conditions.
(Explain in detail;
see
instructions.
Written agreements must
be attached.):
Written Agreement/Arrangement
KJM Consultants
Proposal/Contract for: Johns Hopkins Hospital
Date: February 21, 2023
Statement of work:
Kirsten Johnson Moore, an individual with healthcare leadership and labor relations expertise, will supplement your existing organizational team as a facilitator to coach and mentor your managerial team and engage with employees regarding the process of union representation under the National Labor Relations Act.
Terms and Conditions:
Fees: The consulting fee rate is $350.00 per ho
Specific Activities to be performed
Activity1
11. For each activity, separately list in detail the information required.
(See instructions.)
a. Nature of activity:To coach and mentor your managerial team and engage with employees regarding the process of union representation under the National Labor Relations Act.
11.b.Period during which activities
performed:
02/21/2023
11.c. Extent of performance:
04/04/2023
11.d.
Name and address of person(s) through
whom
activities were performed or will be performed:
Name:Kirsten Johnson Moore Organization:KJM Consultants