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-69189      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:Johan Pena
Title:Consultant
Organization:Johan Pena
P.O. Box., Bldg., Room No., if any:
Street:15815 SW 103 Ln
City:MiamiState:FL
ZIP code:33196
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: Johan Pena
Title: PRESIDENT
Date: Jul 25, 2022
Telephone Number: 305-926-8230
18.
SIGNED: Johan Pena
Title: TREASURER
Date: Jul 25, 2022
Telephone Number: 305-926-8230
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: Fragrancenet.com
Trade Name:
Name: Allison Argiro
Title:
Mailing Address:
P.O. Box., Bldg., Room No., if any:900 Grand Boulevard
Street:
City:Deer parkState:NY
ZIP code:11729
  5.b.Termination Date: 5.c.Amount:$5,791      Non-Cash Payment:
    Type of Payment:

5.a.Name and Address of Employer (including trade name, if any).
Employer: Quests La Ricura
Trade Name: Quezos la Ricura
Name: Esther Pacheco
Title:
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:105-1 Bi-County Boulevard
City:FarmiingdaleState:NY
ZIP code:11735
  5.b.Termination Date: 5.c.Amount:$7,679      Non-Cash Payment:
    Type of Payment:

5.a.Name and Address of Employer (including trade name, if any).
Employer: Mountaire Farms, Inc
Trade Name:
Name: Rodrigo Lozano
Title:
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:29292 Johan J Williams Highway
City:MIllsboroState:DE
ZIP code:19966
  5.b.Termination Date: 5.c.Amount:$72,453      Non-Cash Payment:
    Type of Payment:

5.a.Name and Address of Employer (including trade name, if any).
Employer: Williams-Sonoma, Inc
Trade Name: William Sonoma
Name: Jay Lifschultz
Title:
Mailing Address:
P.O. Box., Bldg., Room No., if any:
Street:7755 Polk Lane
City:Olive BranchState:MS
ZIP code:38654
  5.b.Termination Date: 5.c.Amount:$10,467      Non-Cash Payment:
    Type of Payment:

6.TOTAL RECEIPTS FROM ALL EMPLOYERS: $96,390
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
8. Total disbursements to officers and employees:$0
9. Officer and Administrative Expenses:$0
10. Publicity:$0
11. Fees for Professional Services:$0
12. Loans Made:$0
13. Other Disbursements:$0
14. Total Disbursements (Sum of Items 8-13):$0
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)