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-69686
Amended:
2.
Name and mailing address (including Zip Code):
Name:Justin Shoemaker
Title:Individual
Organization:Individual
EIN:
P.O. Box., Bldg., Room No., if any:PO BOX 983
Street:
City:Pawleys IslandState:SC
ZIP code:29585
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.
X
Individual b.
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:Jay Scheiner
Organization:Timber Ridge SNF Operations LLC
EIN:
Trade Name, if any:Riverview Nursing and Rehabilitation Center
P.O. Box., Bldg., Room No., if any:
Street:1555 East End Boulevard
City:Wilkes-BarreState:PA
ZIP code:18702
7.
Date entered into12/17/2025
8.
Name of person(s) through whom made:
(a) Employer Representative (to be completed by the Primary Consultant):
Name and Title:
OR
(b) Primary Consultant (to be completed by the Sub-consultant):
Name and Title:Michael Ciabattoni, President
Organization:MSC Labor Relations
File Number:69393
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:
Justin Shoemaker
Title:
PRESIDENT
Date:
Jan 15, 2026
Telephone Number:
610-597-1024
14.
SIGNED:
Title:
TREASURER
Date:
Telephone Number:
Form LM-20 (2025)
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
Oral agreement made with MSC Labor Relations, hourly rate, plus actual and reasonable expenses. Agreement has never been reduced to writing, and is for no specific time.
Specific Activities to be performed
Activity1
11. For each activity, separately list in detail the information required.
(See instructions.)
a. Nature of activity:Engaged with employees in voluntary meetings and discussions to provide information and answer questions about employees' Section Seven rights under the National Labor Relations Act, as well as NLRB elections, and unions in general.
11.b.Period during which activities
performed:
Various days beginning 12/17/2025
11.c. Extent of performance:
Ongoing
11.d.
Name and address of person(s) through
whom
activities were performed or will be performed:
P.O. Box, Bldg., Room No., If any:PO Box 983Street:City:Pawleys IslandState:SCZip:29585
12.a. Identify subject groups of employees:
Included: All full-time and regular part-time Maintenance Workers, Activity Assistants, Nursing Assistants, Restorative Assistants, Licensed Practical Nurses, Transportation Assistants, and Nursing Assistant Trainees employed by the Employer at its 1555 East End Boulevard, Wilkes-Barre, PA facility.
Excluded: All other employees, per diem employees, professional employees, confidential employees, managers, guards and supervisors as defined in the Act.