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-70255      2. Period Covered by this report From: 01/01/2023 Through: 12/30/2023
A. Person Filing
3. Name and mailing address (including Zip Code):
Name:Fernando A Rivera
Title:presidente
Organization:Fernando A Rivera
P.O. Box., Bldg., Room No., if any:79283
Street:1941 California Ave
City:CoronaState:CA
ZIP code:92877 - 9998
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 the Section on penalties in the instructions.)
17.
SIGNED: Fernando A Rivera
Title: PRESIDENT
Date: Mar 27, 2024
Telephone Number: 909-904-1474
18.
SIGNED:
Title: TREASURER
Date:
Telephone Number:
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: Breakthru Beverage California, LLC
Trade Name:
Name: Erick Sytsma
Title: Vice President
Mailing Address:
P.O. Box., Bldg., Room No., if any:3333
Street:S. Laramie Ave.,
City:CiceroState:IL
ZIP code:60804
  5.b.Termination Date: 06/15/2023 5.c.Amount:$51,230      Non-Cash Payment:X
    Type of Payment: Wire

5.a.Name and Address of Employer (including trade name, if any).
Employer: AFP Management Corp.
Trade Name:
Name: Michael J. Weinbaum
Title: President
Mailing Address:
P.O. Box., Bldg., Room No., if any:9
Street:Park Place-4th Floor
City:Great NeckState:NY
ZIP code:11021
  5.b.Termination Date: 04/01/2023 5.c.Amount:$29,224      Non-Cash Payment:X
    Type of Payment: Wire

5.a.Name and Address of Employer (including trade name, if any).
Employer: Thai Summit
Trade Name:
Name: Marissa Bruski
Title: HR Manager
Mailing Address:
P.O. Box., Bldg., Room No., if any:1480
Street:McPherson
City:HowellState:MI
ZIP code:48183
  5.b.Termination Date: 5.c.Amount:      Non-Cash Payment:X
    Type of Payment: Cheque

6.TOTAL RECEIPTS FROM ALL EMPLOYERS: $80,454
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
Fernando Rivera$102,250$27,154$129,404
8. Total disbursements to officers and employees:$129,404
9. Officer and Administrative Expenses:$1,500
10. Publicity:
11. Fees for Professional Services:
12. Loans Made:
13. Other Disbursements:
14. Total Disbursements (Sum of Items 8-13):$130,904
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)