FORM
LM-21 - RECEIPTS
& DISBURSEMENTS REPORT
OMB No. 1245-0003 . Expires 01-31-2025 .
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-633      2. Period Covered by this report From: 01/01/2021 Through: 12/31/2021
A. Person Filing
3. Name and mailing address (including Zip Code):
Name:Michael Dana Penn
Title:Partner
Organization:The Crossroads Group Labor Relations Consultants
P.O. Box., Bldg., Room No., if any:Suite 505
Street:63 Via Pico Plaza
City:San ClementeState:CA
ZIP code:92672
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: Michael D Penn
Title: PRESIDENT
Date: Mar 12, 2022
Telephone Number: 818-999-5632
18.
SIGNED: Steven A Beyer
Title: TREASURER
Date: Mar 13, 2022
Telephone Number: 949-248-0884
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: Ecolab, Inc.
Trade Name:
Name: Elliot Goldman
Title: VP, Labor Relations
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:355 Hastings Avenue
City:Highland ParkState:MN
ZIP code:60035
  5.b.Termination Date: 12/09/2020 5.c.Amount:$42,766      Non-Cash Payment:
    Type of Payment: Checks

5.a.Name and Address of Employer (including trade name, if any).
Employer: United Site Services, Inc.
Trade Name:
Name: Jeff G Dunlop
Title: VP & General Counsel
Mailing Address:
P.O. Box., Bldg., Room No., if any:Ste. 1000
Street:118 Flanders Road
City:WestboroughState:MN
ZIP code:01518
  5.b.Termination Date: 08/11/2020 5.c.Amount:$3,722      Non-Cash Payment:
    Type of Payment: Checks

5.a.Name and Address of Employer (including trade name, if any).
Employer: WB Mason
Trade Name:
Name: Chris Meehan
Title: COO
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:647 Summer Street
City:BostonState:MN
ZIP code:02210
  5.b.Termination Date: 10/31/2019 5.c.Amount:$4,940      Non-Cash Payment:
    Type of Payment: Checks

5.a.Name and Address of Employer (including trade name, if any).
Employer: Diversified Glass & Storefronts, Inc.
Trade Name:
Name: John (Sean) G Quinn
Title: President
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:8 Olympic Drive
City:OrangeburgState:MN
ZIP code:10962
  5.b.Termination Date: 06/30/2021 5.c.Amount:$37,447      Non-Cash Payment:
    Type of Payment: Checks

5.a.Name and Address of Employer (including trade name, if any).
Employer: Sunwise Automotive Group
Trade Name: Audi of Concord
Name: David A Hosilyk
Title: General Counsel
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:1300 Concord Avenue
City:ConcordState:MN
ZIP code:94520
  5.b.Termination Date: 03/10/2021 5.c.Amount:$20,940      Non-Cash Payment:
    Type of Payment: Checks

5.a.Name and Address of Employer (including trade name, if any).
Employer: Nuvance Health
Trade Name: Northern Dutchess Hospital
Name: Katie Rosen
Title: Director, Labor Relations
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:24 Hospital Avenue
City:DanburyState:MN
ZIP code:06810
  5.b.Termination Date: 04/24/2021 5.c.Amount:$56,206      Non-Cash Payment:
    Type of Payment: Checks

5.a.Name and Address of Employer (including trade name, if any).
Employer: Euromotors of Oakland
Trade Name: Mercedes-Benz of Oakland
Name: Debbie Ruble
Title: CFO
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:2915 Broadway
City:OaklandState:MN
ZIP code:94611
  5.b.Termination Date: 04/06/2021 5.c.Amount:$33,008      Non-Cash Payment:
    Type of Payment: Checks

5.a.Name and Address of Employer (including trade name, if any).
Employer: Capstone Logistics, LLC
Trade Name:
Name: Barry Boyles
Title: Sr. VP, HR
Mailing Address:
P.O. Box., Bldg., Room No., if any:Ste. 520
Street:30 Technology Parkway South
City:Peachtree CornersState:MN
ZIP code:30092
  5.b.Termination Date: 04/24/2021 5.c.Amount:$14,040      Non-Cash Payment:
    Type of Payment: Checks

5.a.Name and Address of Employer (including trade name, if any).
Employer: Metal-Matic, Inc.
Trade Name:
Name: Sanjeev Deshpande
Title: President
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:629 2nd Street SE
City:MinneapolisState:MN
ZIP code:55414
  5.b.Termination Date: 06/09/2021 5.c.Amount:$49,072      Non-Cash Payment:
    Type of Payment: Checks

5.a.Name and Address of Employer (including trade name, if any).
Employer: CARA Veterinary
Trade Name: All Creatures Animal Hospital
Name: Peter Brown
Title: President
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:363 South Forest Street
City:BellinghamState:WA
ZIP code:98225
  5.b.Termination Date: 05/21/2021 5.c.Amount:$17,622      Non-Cash Payment:
    Type of Payment: Checks

5.a.Name and Address of Employer (including trade name, if any).
Employer: Urbana (Geary & Mission)
Trade Name:
Name: Marty Higgins
Title: Principal
Mailing Address:
P.O. Box., Bldg., Room No., if any:Suite B
Street:1565 Madison Street
City:OaklandState:CA
ZIP code:94612
  5.b.Termination Date: 06/11/2021 5.c.Amount:$4,188      Non-Cash Payment:
    Type of Payment: Checks

5.a.Name and Address of Employer (including trade name, if any).
Employer: Wicor Autos, Inc.
Trade Name: Totota Vallejo
Name: Dave Johnston
Title: General Manager
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:201 Auto Mall Parkway
City:VallejoState:CA
ZIP code:94591
  5.b.Termination Date: 07/16/2021 5.c.Amount:$4,456      Non-Cash Payment:
    Type of Payment: Checks

5.a.Name and Address of Employer (including trade name, if any).
Employer: LafargeHolcim
Trade Name: Lattimore Materials Corp.
Name: Robert Winningham
Title: Director, HR
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:15900 Dooley Road
City:AddisonState:TX
ZIP code:75001
  5.b.Termination Date: 09/17/2021 5.c.Amount:$22,859      Non-Cash Payment:
    Type of Payment: Checks

5.a.Name and Address of Employer (including trade name, if any).
Employer: Rehobath McKinley Christian Health Care Services
Trade Name:
Name: Sam McDowell
Title: Accounts Payable
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:1901 Red Rock Drive
City:GallupState:NM
ZIP code:87301
  5.b.Termination Date: 09/10/2021 5.c.Amount:$13,116      Non-Cash Payment:
    Type of Payment: Checks

5.a.Name and Address of Employer (including trade name, if any).
Employer: McLean Hospital
Trade Name:
Name: Scott Rauch
Title: President
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:115 Mill Street
City:BelmontState:MA
ZIP code:02478
  5.b.Termination Date: Ongoing 5.c.Amount:$37,384      Non-Cash Payment:
    Type of Payment: Checks

5.a.Name and Address of Employer (including trade name, if any).
Employer: Start Elevator, LLC
Trade Name:
Name: John O'Shea
Title: President
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:4350 Bullard Avenue
City:BronxState:NY
ZIP code:10466
  5.b.Termination Date: Ongoing 5.c.Amount:$16,985      Non-Cash Payment:
    Type of Payment: Checks

5.a.Name and Address of Employer (including trade name, if any).
Employer: White Plains Hospital
Trade Name:
Name: Diane Wooley
Title: CHRO
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:41 East Post Road
City:White PlainsState:NY
ZIP code:10601
  5.b.Termination Date: Ongoing 5.c.Amount:$187,046      Non-Cash Payment:
    Type of Payment: Checks

5.a.Name and Address of Employer (including trade name, if any).
Employer: Immaculate Mary Center
Trade Name:
Name: Millard D Freeman
Title: Administrator
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:2990 Holme Avenue
City:PhiladelphiaState:PA
ZIP code:19136
  5.b.Termination Date: 12/07/2021 5.c.Amount:$28,514      Non-Cash Payment:
    Type of Payment: Checks

5.a.Name and Address of Employer (including trade name, if any).
Employer: HCA Healthcare, Inc.
Trade Name: Riverside Community Hospital
Name: Jackie DeSouza
Title: President & CEO
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:4445 Magnolia Avenue
City:RiversideState:CA
ZIP code:92501
  5.b.Termination Date: 06/04/2021 5.c.Amount:$3,605      Non-Cash Payment:
    Type of Payment: Checks

5.a.Name and Address of Employer (including trade name, if any).
Employer: Pathway Vet Alliance
Trade Name:
Name: Tracey Shields
Title: VP of People Operations
Mailing Address:
P.O. Box., Bldg., Room No., if any:Suite B100
Street:800 W. Cesar Chavez Street
City:AustinState:TX
ZIP code:78701
  5.b.Termination Date: 12/17/2021 5.c.Amount:$52,829      Non-Cash Payment:
    Type of Payment: Checks

6.TOTAL RECEIPTS FROM ALL EMPLOYERS: $650,745
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
Steven A Beyer$115,034$14,795$129,829
Michael Dana Penn$178,518$18,604$197,122
8. Total disbursements to officers and employees:$326,951
9. Officer and Administrative Expenses:
10. Publicity:
11. Fees for Professional Services:
12. Loans Made:
13. Other Disbursements:
14. Total Disbursements (Sum of Items 8-13):$326,951
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.
15.a. Employer Name: Immaculate Mary Center

15.c. To Whom Paid:
Name: Miko A Penn
Title: Sr. Labor Relations Consultant
Organization: The MayDay Group, Inc.
P.O. Box., Bldg., Room No., if any:
Street:7550 Chaminade Avenue
City:West HillsState:CA
ZIP code:91304 - 5384
15.b. Trade Name, If any:
15.d.Amount:$19,160
15.e.Purpose: To assist the employer in its communication efforts to advise its employees of their Section 7 rights and furnish them with information regarding third-party representation
15.a. Employer Name: White Plains Hospital

15.c. To Whom Paid:
Name: Miko A Penn
Title: Sr. Labor Relations Consultant
Organization: The MayDay Group, Inc.
P.O. Box., Bldg., Room No., if any:
Street:7550 Chaminade Avenue
City:West HillsState:CA
ZIP code:91304 - 5384
15.b. Trade Name, If any:
15.d.Amount:$144,473
15.e.Purpose: To assist the employer in its communication efforts to advise its employees of their Section 7 rights and furnish them with information regarding third-party representation
15.a. Employer Name: HCA Healthcare, Inc.

15.c. To Whom Paid:
Name: Miko A Penn
Title: Sr. Labor Relations Consultant
Organization: The MayDay Group, Inc.
P.O. Box., Bldg., Room No., if any:
Street:7550 Chaminade Avenue
City:West HillsState:CA
ZIP code:91304 - 5384
15.b. Trade Name, If any:
Riverside Community Hospital
15.d.Amount:$2,729
15.e.Purpose: To assist the employer in its communication efforts to advise its employees of their Section 7 rights and furnish them with information regarding third-party representation
15.a. Employer Name: Pathway Vet Alliance

15.c. To Whom Paid:
Name: Miko A Penn
Title: Sr, Labor Relations Consultant
Organization: The MayDay Group, Inc.
P.O. Box., Bldg., Room No., if any:
Street:7550 Chaminade Avenue
City:West HillsState:CA
ZIP code:91304 - 5384
15.b. Trade Name, If any:
15.d.Amount:$40,703
15.e.Purpose: To assist the employer in its communication efforts to advise its employees of their Section 7 rights and furnish them with information regarding third-party representation
16.TOTAL DISBURSEMENTS FOR ALL REPORTABLE ACTIVITY: $207,065
Form LM-21 (2003)