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-633
Amended:
2.
Name and mailing address (including Zip Code):
Name:Michael Dana Penn
Title:Partner
Organization:THE CROSSROADS GROUP LABOR RELATION CONSULTANTS
P.O. Box., Bldg., Room No., if any:505
Street:63 Via Pico Plaza
City:San ClementeState:CA
ZIP code:92672
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 /31
5.
Type of person
a.
Individual b.
X
Partnership
c.
Corporation C d.
Other
Specify:
Nature of Agreement or Arrangement
6.
Full name and address of employer with whom made (include ZIP Code):
Name:Scott Edelman
Organization:Burke Rehabilitation Hospital
Trade Name, if any:
P.O. Box., Bldg., Room No., if any:
Street:785 Mamaroneck Avenue
City:White PlainsState:NY
ZIP code:10605
7.
Date entered into05/12/2024
8.
Name of person(s) through whom made:
Name:Scott Edelman
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
VIII on
penalties in the
instructions.)
13.
SIGNED:
Michael D Penn
Title:
PRESIDENT
Date:
Jun 10, 2024
Telephone Number:
818-999-5632
14.
SIGNED:
Steven A Beyer
Title:
TREASURER
Date:
Jun 11, 2024
Telephone Number:
949-248-0884
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.):
XWritten Agreement/Arrangement
Payment on a fee-for-service basis at an hourly rate of $450, plus reasonable and customary expenses. These services are not contemplated for any specific time and may be terminated by either party at any time.
Specific Activities to be performed
Activity1
11. For each activity, separately list in detail the information required.
(See instructions.)
a. Nature of activity:Provide presentations, prepare written materials, and conduct meetings with management and employees to discuss information related to third-party representation and rights afforded by the National Labor Relations Act (NLRA)
11.b.Period during which activities
performed:
05/14/2024 to Present
11.c. Extent of performance:
Continuing
11.d.
Name and address of person(s) through
whom
activities were performed or will be performed:
Name:Michael Dana Penn Organization:The Crossroads Group Labor Relations Consultants
P.O. Box, Bldg., Room No., If any:Suite 505Street:63 Via Pico PlazaCity:San ClementeState:CAZip:92672
12.a. Identify subject groups of employees:
All employees employed by the Employer at its hospital in White Plains, NY