FORM
LM-21 - RECEIPTS
& DISBURSEMENTS REPORT
OMB No. 1245-0003 . Expires 09-30-2021 .
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. File Number: C-755      2. Period Covered by this report From: 01/01/2020 Through: 12/31/2020
A. Person Filing
3. Name and mailing address (including Zip Code):
Name:DEBORAH LONG
Title:President
Organization:HEALTHCARE LABOR SOLUTIONS
P.O. Box., Bldg., Room No., if any:
Street:4843 COLLEYVILLE BLVD SUITE 251-151
City:COLLEYVILLEState:TX
ZIP code:76034
4. Any 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:
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.)
17.
SIGNED: Deborah Long
Title: PRESIDENT
Date: Apr 01, 2021
Telephone Number: 877-424-9799
18.
SIGNED: Deborah Long
Title: TREASURER
Date: Apr 01, 2021
Telephone Number: 877-424-9799
Form LM-21 (2003)
B.
Statement of Receipts Report all receipts from employers in connection with labor relations advice or services regardless of the purposes of the advice or services.
5.a.Name and Address of Employer (including trade name, if any).
Employer: Palo Alto Medical Foundation
Trade Name:
Name: Maria Morin
Title: HR Director
Mailing Address:
P.O. Box., Bldg., Room No., if any:Suite 100
Street:39650 Liberty Street
City:FremontState:CA
ZIP code:94538
  5.b.Termination Date: 12/01/2020 5.c.Amount:$67,776      Non-Cash Payment:
    Type of Payment: Cash

5.a.Name and Address of Employer (including trade name, if any).
Employer: Sutter Tracy Community Medical Center
Trade Name:
Name: Dominic Mitchell
Title: Director Employee Relations
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:1700 Coffee Road
City:ModestoState:CA
ZIP code:95355
  5.b.Termination Date: 03/13/2020 5.c.Amount:$6,547      Non-Cash Payment:
    Type of Payment: Cash

5.a.Name and Address of Employer (including trade name, if any).
Employer: Chancellor Health Care, LLC
Trade Name:
Name: Michel Augsburger
Title: Owner
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:25383 Cole St.
City:Loma LindaState:CA
ZIP code:92354
  5.b.Termination Date: 11/19/2019 5.c.Amount:$61,068      Non-Cash Payment:
    Type of Payment: Cash

5.a.Name and Address of Employer (including trade name, if any).
Employer: Sutter Shared Lab
Trade Name:
Name: Dominic Mitchell
Title: Dir Employee Relations
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:2950 Collier Canyon Rd.
City:LivermoreState:CA
ZIP code:94551
  5.b.Termination Date: 03/13/2020 5.c.Amount:$19,012      Non-Cash Payment:
    Type of Payment: Cash

5.a.Name and Address of Employer (including trade name, if any).
Employer: Jersey Shore University Medical Center
Trade Name:
Name: Nancy Corcoran Davidoff
Title: CHRO
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:343 Thornall Street
City:EdisonState:CA
ZIP code:08837
  5.b.Termination Date: Ongoing 5.c.Amount:$996,903      Non-Cash Payment:
    Type of Payment: Cash

5.a.Name and Address of Employer (including trade name, if any).
Employer: Palo Alto Medical Foundation
Trade Name:
Name: Katie Borges
Title: HR Manager
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:2751 Research Park Dr.
City:SoquelState:CA
ZIP code:95073
  5.b.Termination Date: 01/07/2020 5.c.Amount:$40,134      Non-Cash Payment:
    Type of Payment: Cash

5.a.Name and Address of Employer (including trade name, if any).
Employer: DaVita, Inc.
Trade Name:
Name: Caitlin Moughon
Title: VP, Associate GC
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:2000 16th Street
City:DenverState:CA
ZIP code:80202
  5.b.Termination Date: Ongoing 5.c.Amount:$1,586,806      Non-Cash Payment:
    Type of Payment: Cash

5.a.Name and Address of Employer (including trade name, if any).
Employer: Hall Ambulance
Trade Name:
Name: Jonathan Surface
Title: Manager
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:1001 21st Street
City:BakersfieldState:CA
ZIP code:93301
  5.b.Termination Date: 02/21/2020 5.c.Amount:$192,248      Non-Cash Payment:
    Type of Payment: Cash

6.TOTAL RECEIPTS FROM ALL EMPLOYERS: $2,970,494
C.
Statement of Disbursements Report all disbursements made by the reporting organization in connection with labor relations advice or services rendered to the employers listed in Part B.
7.
Disbursements to Officers and Employees:
(a) Name(b) Salary(c) Expense(d) Totals
Deborah Long$260,000$38,639$298,639
Timothy Long$60,000$0$60,000
Cody Long$30,000$0$30,000
Kaydee Long$30,000$0$30,000
8. Total disbursements to officers and employees:$418,639
9. Officer and Administrative Expenses:$2,000
10. Publicity:$0
11. Fees for Professional Services:$2,549,855
12. Loans Made:$0
13. Other Disbursements:$0
14. Total Disbursements (Sum of Items 8-13):$2,970,494
Form LM-21 (2003)
D.
Schedule of Disbursements for Reportable Activity Use this schedule to report only disbursements made for the purposes described in Part D of the instructions.
Form LM-21 (2003)