U.S. Department of Labor
Office of Labor-Management Standards
Washington, DC 20210
FORM LM-2 LABOR ORGANIZATION ANNUAL REPORT
Form Approved
Office of Management and Budget
No.
1245-0003
Expires:
07-31-2019
MUST BE USED BY LABOR ORGANIZATIONS WITH $250,000 OR
MORE IN TOTAL ANNUAL RECEIPTS AND LABOR ORGANIZATIONS IN
TRUSTEESHIP
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.
READ THE INSTRUCTIONS CAREFULLY BEFORE PREPARING THIS
REPORT.
For Official Use Only
1. FILE NUMBER
024-068
2.
PERIOD COVERED
From
07/01/2015
Through
06/30/2016
3.
(a) AMENDED - Is this an amended report:
No
(b) HARDSHIP - Filed under the hardship procedures:
No
(c) TERMINAL - This
is a terminal report:
No
4. AFFILIATION OR ORGANIZATION NAME
FOOD AND COMMERCIAL WKRS
5. DESIGNATION (Local, Lodge, etc.)
LOCAL UNION
6. DESIGNATION NBR
648
7. UNIT NAME (if any)
8. MAILING ADDRESS (Type or print in capital
letters)
First Name
DANIEL
Last Name
LARSON
P.O Box - Building and Room Number
Number and Street
1980 MISSION ST
City
SAN FRANCISCO
State
CA
ZIP Code + 4
941033405
9. Are your organization's records kept at its
mailing address?
Yes
Each of the undersigned, duly authorized
officers of the above labor organization, declares,
under penalty of perjury and other applicable penalties
of law, that all of the information submitted in this
report (including information contained in any
accompanying documents) has been examined by the
signatory and is, to the best of the undersigned
individual's knowledge and belief, true, correct
and complete (See Section V on penalties in the
instructions.)
70. SIGNED:
DANIEL A LARSON
PRESIDENT
71. SIGNED:
Milton Hum
TREASURER
Date:
Oct 04, 2016
Telephone
Number:
415-861-7840
Date:
Oct 04, 2016
Telephone
Number:
415-861-7840
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
ITEMS 10 THROUGH 21
FILE NUMBER:
024-068
10. During the reporting period did the labor
organization create or participate in the administration of
a trust or a fund or organization, as defined in the
instructions, which provides benefits for members or
beneficiaries?
Yes
11(a). During the reporting period did the
labor organization have a political action committee (PAC)
fund?
Yes
11(b). During the reporting period did the
labor organization have a subsidiary organization as
defined in Section X of these Instructions?
No
12. During the reporting period did the labor
organization have an audit or review of its books and
records by an outside accountant or by a parent body
auditor/representative?
Yes
13. During the reporting period did the labor
organization discover any loss or shortage of funds or
other assets? (Answer "Yes" even if there has
been repayment or recovery.)
No
14. What is the maximum amount recoverable
under the labor organization's fidelity bond for a
loss caused by any officer, employee or agent of the labor
organization who handled union funds?
$500,000
15. During the reporting period did the labor
organization acquire or dispose of any assets in a manner
other than purchase or sale?
No
16. Were any of the labor organization's
assets pledged as security or encumbered in any way at the
end of the reporting period?
No
17. Did the labor organization have any
contingent liabilities at the end of the reporting period?
Yes
18. During the reporting period did the labor
organization have any changes in its constitution or
bylaws, other than rates of dues and fees, or in
practices/procedures listed in the instructions?
No
19. What is the date of the labor
organization's next regular election of officers?
07/2016
20. How many members did the labor organization
have at the end of the reporting period?
3,755
21. What are the labor organization's rates of dues
and fees?
Rates of Dues and Fees
Dues/Fees
Amount
Unit
Minimum
Maximum
(a) Regular Dues/Fees
$33.50-$42.50
per
Month
$33.50
$42.50
(b) Working Dues/Fees
N/A
per
N/A
N/A
N/A
(c) Initiation Fees
$210-$350
per
Initiation
$210
$350
(d) Transfer Fees
N/A
per
N/A
N/A
N/A
(e) Work Permits
N/A
per
N/A
N/A
N/A
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
STATEMENT A - ASSETS
AND LIABILITIES
FILE NUMBER:
024-068
ASSETS
ASSETS
Schedule
Number
Start of Reporting Period
(A)
End of Reporting Period
(B)
22. Cash
$790,726
$767,158
23. Accounts Receivable
1
$0
24. Loans Receivable
2
25. U.S. Treasury
Securities
$0
$0
26. Investments
5
$859,656
$870,476
27. Fixed Assets
6
$310,562
$273,789
28. Other Assets
7
$9,967
29.
TOTAL ASSETS
$1,960,944
$1,921,390
LIABILITIES
LIABILITIES
Schedule
Number
Start of Reporting Period
(A)
End of Reporting Period
(B)
30. Accounts Payable
8
31. Loans Payable
9
32. Mortgages Payable
$0
$0
33. Other Liabilities
10
$4,784
$2,584
34. TOTAL
LIABILITIES
$4,784
$2,584
35. NET
ASSETS
$1,956,160
$1,918,806
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
STATEMENT B -
RECEIPTS AND DISBURSEMENTS
FILE NUMBER:
024-068
CASH
RECEIPTS
SCH
AMOUNT
36. Dues and Agency Fees
$1,993,660
37. Per Capita Tax
$0
38. Fees, Fines,
Assessments, Work Permits
$209,278
39. Sale of Supplies
$9,546
40. Interest
$374
41. Dividends
$0
42. Rents
$35,293
43. Sale of Investments
and Fixed Assets
3
44. Loans Obtained
9
45. Repayments of Loans
Made
2
46. On Behalf of
Affiliates for Transmittal to Them
$0
47. From Members for
Disbursement on Their Behalf
$0
48. Other Receipts
14
$165,485
49. TOTAL RECEIPTS
$2,413,636
CASH DISBURSEMENTS
SCH
AMOUNT
50.
Representational Activities
15
$766,420
51.
Political Activities and Lobbying
16
$17,150
52.
Contributions, Gifts, and Grants
17
$15,540
53. General
Overhead
18
$403,893
54. Union
Administration
19
$37,272
55. Benefits
20
$283,820
56. Per
Capita Tax
$802,056
57. Strike
Benefits
$0
58. Fees,
Fines, Assessments, etc.
$0
59. Supplies
for Resale
$9,542
60. Purchase
of Investments and Fixed Assets
4
$4,347
61. Loans
Made
2
62.
Repayment of Loans Obtained
9
63. To
Affiliates of Funds Collected on Their Behalf
$0
64. On
Behalf of Individual Members
$0
65. Direct
Taxes
$94,965
66. Subtotal
$2,435,005
67.
Withholding Taxes and Payroll Deductions
67a. Total
Withheld
$265,247
67b. Less Total
Disbursed
$267,447
67c.
Total Withheld But Not Disbursed
-$2,200
68.
TOTAL DISBURSEMENTS
$2,437,205
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 1 - ACCOUNTS
RECEIVABLE AGING SCHEDULE
FILE NUMBER:
024-068
Entity or Individual Name
(A)
Total Account Receivable
(B)
90-180 Days
Past Due
(C)
180+ Days
Past Due
(D)
Liquidated Account
Receivable
(E)
Total of all itemized
accounts receivable
$0
$0
$0
$0
Totals from all other
accounts receivable
Totals
(Total of Column (B) will be automatically entered in Item
23, Column(B))
$0
$0
$0
$0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 2 - LOANS
RECEIVABLE
FILE NUMBER:
024-068
List below loans to officers, employees, or members which
at any time during the reporting period exceeded $250 and
list all loans to business enterprises regardless of amount.
(A)
Loans
Outstanding at
Start of Period
(B)
Loans Made
During Period
(C)
Repayments Received During Period
Cash
(D)(1)
Other Than Cash
(D)(2)
Loans
Outstanding at
End of Period
(E)
Total of loans not
listed above
Total of all lines
above
$0
$0
$0
$0
$0
Totals will be
automatically entered in...
Item 24
Column (A)
Item 61
Item 45
Item 69
with Explanation
Item 24
Column (B)
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 3 - SALE OF
INVESTMENTS AND FIXED ASSETS
FILE NUMBER:
024-068
Description (if land or buildings, give location)
(A)
Cost
(B)
Book Value
(C)
Gross Sales Price
(D)
Amount Received
(E)
Total of all
lines above
$0
$0
$0
$0
Less Reinvestments
(The
total from Net Sales Line will be automatically entered
in Item 43)
Net Sales
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 4 - PURCHASE
OF INVESTMENTS AND FIXED ASSETS
FILE NUMBER:
024-068
Description (if land or buildings, give location)
(A)
Cost
(B)
Book Value
(C)
Cash Paid
(D)
Total
of all lines above
$4,347
$4,347
$4,347
Office Furniture & Equipment
$547
$547
$547
Building Improvements
$3,800
$3,800
$3,800
Less Reinvestments
$0
(The
total from Net Purchases Line will be automatically
entered in Item 60.)
Net Purchases
$4,347
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 5 -
INVESTMENTS
FILE NUMBER:
024-068
Description
(A)
Amount
(B)
Marketable Securities
A. Total Cost
$822,450
B. Total Book Value
$870,476
C. List each
marketable security which has a book value over $5,000
and exceeds 5% of Line B.
California St Var Purp Genl Oblig 6.20% 3/1/2019
$56,690
Orange Cnty Wastewater REV-A 5.56% 2/2/2036
$129,858
California St Var Purp Genl Oblig 7.95% 3/1/2036
$121,174
Money Market Fund
$562,754
Other Investments
D. Total Cost
E. Total Book Value
F. List each other
investment which has a book value over $5,000 and
exceeds 5% of Line E. Also, list each subsidiary
for which separate reports are attached.
G. Total of Lines B and E
(Total will be automatically entered in Item 26,
Column(B))
$870,476
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 6 - FIXED
ASSETS
FILE NUMBER:
024-068
Description
(A)
Cost or Other Basis
(B)
Total Depreciation or
Amount Expensed
(C)
Book Value
(D)
Value
(E)
A.
Land (give location)
Land
1
:
1980 Mission Street, San Francisco, CA 94103
$86,239
$86,239
$86,239
B.
Buildings (give location)
Building
1
:
1980 Mission Street, San Francisco, CA 94103
$686,495
$512,489
$174,006
$174,006
C. Automobiles
and
Other Vehicles
D. Office
Furniture
and Equipment
$207,456
$193,912
$13,544
$13,544
E.
Other Fixed Assets
F. Totals of Lines A through E
(Column(D) Total will be automatically entered in Item
27, Column(B))
$980,190
$706,401
$273,789
$273,789
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 7 - OTHER
ASSETS
FILE NUMBER:
024-068
Description
(A)
Book Value
(B)
Total
(Total will be automatically entered in Item 28, Column(B))
$9,967
Prepaid Payroll
$9,967
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 8 - ACCOUNTS
PAYABLE AGING SCHEDULE
FILE NUMBER:
024-068
Entity or Individual Name
(A)
Total Account
Payable
(B)
90-180 Days
Past Due
(C)
180+ Days Past
Due
(D)
Liquidated Account
Payable
(E)
Total for all itemized accounts payable
$0
$0
$0
$0
Total from all other accounts payable
$0
$0
$0
$0
Totals
(Total for Column(B) will be automatically entered in Item
30, Column(D))
$0
$0
$0
$0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 9 - LOANS
PAYABLE
FILE NUMBER:
024-068
Source of Loans Payable at Any
Time During the Reporting Period
(A)
Loans Owed at
Start of Period
(B)
Loans Obtained
During Period
(C)
Repayment
During Period
Cash
(D)(1)
Repayment
During Period
Other Than Cash
(D)(2)
Loans Owed at
End of Period
(E)
Total Loans Payable
$0
$0
$0
$0
$0
Totals will be automatically entered in...
Item 31
Column (C)
Item 44
Item 62
Item 69
with Explanation
Item 31
Column (D)
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 10 - OTHER
LIABILITIES
FILE NUMBER:
024-068
Description
(A)
Amount at End of Period
(B)
Total Other Liabilities
(Total will be automatically entered in Item 33, Column(D))
$2,584
Payroll Liabilities
$2,584
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 11 - ALL
OFFICERS AND DISBURSEMENTS TO OFFICERS
FILE NUMBER:
024-068
(A) Name
(B) Title
(C) Status
(D)
Gross Salary
Disbursements
(before any
deductions)
(E)
Allowances
Disbursed
(F)
Disbursements
for Official Business
(G)
Other
Disbursements not reported in
(D) through (F)
(H)
TOTAL
A
B
C
LARSON
,
DANIEL
PRESIDENT C
$109,120
$0
$20,675
$0
$129,795
I
Schedule 15
Representational Activities
90
%
Schedule 16
Political Activities and Lobbying
1
%
Schedule 17
Contributions
1
%
Schedule 18
General Overhead
5
%
Schedule 19
Administration
3
%
A
B
C
HUM
,
MILTON
SECRETARY-TREASURER C
$98,595
$0
$5,683
$0
$104,278
I
Schedule 15
Representational Activities
84
%
Schedule 16
Political Activities and Lobbying
5
%
Schedule 17
Contributions
1
%
Schedule 18
General Overhead
5
%
Schedule 19
Administration
5
%
A
B
C
SALAZAR
,
CYNTHIA
RECORDER C
$68,269
$450
$1,200
$0
$69,919
I
Schedule 15
Representational Activities
25
%
Schedule 16
Political Activities and Lobbying
0
%
Schedule 17
Contributions
2
%
Schedule 18
General Overhead
68
%
Schedule 19
Administration
5
%
A
B
C
TASSONE
,
JAMES
VICE PRESIDENT C
$0
$45
$0
$0
$45
I
Schedule 15
Representational Activities
0
%
Schedule 16
Political Activities and Lobbying
0
%
Schedule 17
Contributions
0
%
Schedule 18
General Overhead
0
%
Schedule 19
Administration
100
%
A
B
C
YUEN
,
DENNIS
VICE PRESIDENT C
$0
$360
$38
$0
$398
I
Schedule 15
Representational Activities
0
%
Schedule 16
Political Activities and Lobbying
0
%
Schedule 17
Contributions
0
%
Schedule 18
General Overhead
0
%
Schedule 19
Administration
100
%
A
B
C
VILLASIN
,
MARIA
VICE PRESIDENT C
$0
$450
$0
$0
$450
I
Schedule 15
Representational Activities
0
%
Schedule 16
Political Activities and Lobbying
0
%
Schedule 17
Contributions
0
%
Schedule 18
General Overhead
0
%
Schedule 19
Administration
100
%
A
B
C
NG
,
BARRY
VICE PRESIDENT C
$0
$495
$345
$0
$840
I
Schedule 15
Representational Activities
0
%
Schedule 16
Political Activities and Lobbying
0
%
Schedule 17
Contributions
0
%
Schedule 18
General Overhead
0
%
Schedule 19
Administration
100
%
A
B
C
HERBERT
,
MICHELLE
VICE PRESIDENT C
$0
$405
$0
$0
$405
I
Schedule 15
Representational Activities
0
%
Schedule 16
Political Activities and Lobbying
0
%
Schedule 17
Contributions
0
%
Schedule 18
General Overhead
0
%
Schedule 19
Administration
100
%
A
B
C
SALAZAR
,
MICHELLE
VICE PRESIDENT C
$0
$225
$0
$0
$225
I
Schedule 15
Representational Activities
0
%
Schedule 16
Political Activities and Lobbying
0
%
Schedule 17
Contributions
0
%
Schedule 18
General Overhead
0
%
Schedule 19
Administration
100
%
A
B
C
VASILEVSKAYA
,
POLINA
VICE PRESIDENT C
$0
$315
$0
$0
$315
I
Schedule 15
Representational Activities
0
%
Schedule 16
Political Activities and Lobbying
0
%
Schedule 17
Contributions
0
%
Schedule 18
General Overhead
0
%
Schedule 19
Administration
100
%
A
B
C
DE GUZMAN
,
MICHELLE
VICE PRESIDENT C
$0
$0
$0
$0
$0
I
Schedule 15
Representational Activities
0
%
Schedule 16
Political Activities and Lobbying
0
%
Schedule 17
Contributions
0
%
Schedule 18
General Overhead
0
%
Schedule 19
Administration
100
%
A
B
C
ROBERTS
,
DARRYL
VICE PRESIDENT C
$85,292
$405
$3,411
$0
$89,108
I
Schedule 15
Representational Activities
94
%
Schedule 16
Political Activities and Lobbying
1
%
Schedule 17
Contributions
0
%
Schedule 18
General Overhead
0
%
Schedule 19
Administration
5
%
A
B
C
DANIELS
,
BRYANT
VICE PRESIDENT C
$0
$90
$0
$0
$90
I
Schedule 15
Representational Activities
0
%
Schedule 16
Political Activities and Lobbying
0
%
Schedule 17
Contributions
0
%
Schedule 18
General Overhead
0
%
Schedule 19
Administration
100
%
A
B
C
PRADIA
,
CHRISTIAN
VICE PRESIDENT C
$85,772
$315
$3,709
$0
$89,796
I
Schedule 15
Representational Activities
91
%
Schedule 16
Political Activities and Lobbying
1
%
Schedule 17
Contributions
0
%
Schedule 18
General Overhead
3
%
Schedule 19
Administration
5
%
A
B
C
MCLAUGHLIN
,
TIM
VICE PRESIDENT C
$85,332
$405
$3,491
$0
$89,228
I
Schedule 15
Representational Activities
94
%
Schedule 16
Political Activities and Lobbying
1
%
Schedule 17
Contributions
0
%
Schedule 18
General Overhead
0
%
Schedule 19
Administration
5
%
A
B
C
LOPEZ
,
ALFONSO
VICE PRESIDENT C
$0
$135
$0
$0
$135
I
Schedule 15
Representational Activities
0
%
Schedule 16
Political Activities and Lobbying
0
%
Schedule 17
Contributions
0
%
Schedule 18
General Overhead
0
%
Schedule 19
Administration
100
%
A
B
C
SZETO
,
RAYMOND
VICE PRESIDENT C
$0
$270
$0
$0
$270
I
Schedule 15
Representational Activities
0
%
Schedule 16
Political Activities and Lobbying
0
%
Schedule 17
Contributions
0
%
Schedule 18
General Overhead
0
%
Schedule 19
Administration
100
%
A
B
C
NG
,
STEVEN
VICE PRESIDENT C
$0
$450
$0
$0
$450
I
Schedule 15
Representational Activities
0
%
Schedule 16
Political Activities and Lobbying
0
%
Schedule 17
Contributions
0
%
Schedule 18
General Overhead
0
%
Schedule 19
Administration
100
%
Total Officer
Disbursements
$532,380
$4,815
$38,552
$0
$575,747
Less Deductions
$190,114
Net
Disbursements
$385,633
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 12 -
DISBURSEMENTS TO EMPLOYEES
FILE NUMBER:
024-068
(A) Name
(B) Title
(C) Other Payer
(D)
Gross Salary
Disbursements
(before any
deductions)
(E)
Allowances Disbursed
(F)
Disbursements for Official Business
(G)
Other Disbursements not reported in
(D) through (F)
(H)
TOTAL
A
B
C
FLORES
,
MARCO A
MEMBERSHIP DIRECTOR N/A
$63,957
$0
$0
$0
$63,957
I
Schedule 15
Representational Activities
20
%
Schedule 16
Political Activities and Lobbying
0
%
Schedule 17
Contributions
0
%
Schedule 18
General Overhead
80
%
Schedule 19
Administration
0
%
A
B
C
GARCIA
,
JENNIFER
UNION REPRESENTATIVE N/A
$66,586
$0
$5,176
$0
$71,762
I
Schedule 15
Representational Activities
90
%
Schedule 16
Political Activities and Lobbying
10
%
Schedule 17
Contributions
0
%
Schedule 18
General Overhead
0
%
Schedule 19
Administration
0
%
A
B
C
HERNANDEZ
,
JULISSA
ORGANIZER N/A
$38,952
$225
$1,427
$0
$40,604
I
Schedule 15
Representational Activities
100
%
Schedule 16
Political Activities and Lobbying
0
%
Schedule 17
Contributions
0
%
Schedule 18
General Overhead
0
%
Schedule 19
Administration
0
%
A
B
C
LI
,
HAI LAN
OFFICE MANAGER N/A
$83,862
$0
$697
$0
$84,559
I
Schedule 15
Representational Activities
25
%
Schedule 16
Political Activities and Lobbying
0
%
Schedule 17
Contributions
0
%
Schedule 18
General Overhead
70
%
Schedule 19
Administration
5
%
A
B
C
ROSALINA
,
TOLENTINO
DUES REP N/A
$66,382
$0
$0
$0
$66,382
I
Schedule 15
Representational Activities
20
%
Schedule 16
Political Activities and Lobbying
0
%
Schedule 17
Contributions
0
%
Schedule 18
General Overhead
80
%
Schedule 19
Administration
0
%
A
B
C
LOPEZ
,
JEAN
M UNION REPRESENTATIVE N/A
$47,608
$90
$357
$0
$48,055
I
Schedule 15
Representational Activities
94
%
Schedule 16
Political Activities and Lobbying
1
%
Schedule 17
Contributions
0
%
Schedule 18
General Overhead
0
%
Schedule 19
Administration
5
%
TOTALS RECEIVED
BY EMPLOYEES MAKING $10,000 OR LESS
$0
I
Schedule 15
Representational Activities
Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
Total
Employee Disbursements
$367,347
$315
$7,657
$0
$375,319
Less
Deductions
$75,133
Net Disbursements
$300,186
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 13 -
MEMBERSHIP STATUS
FILE NUMBER:
024-068
Category of Membership
(A)
Number
(B)
Voting Eligibility
(C)
Members
(Total of all lines above)
3,755
Agency Fee Payers*
3
Total Members/Fee Payers
3,758
*Agency Fee Payers are
not considered members of the labor organization.
Food Clerk
1,111
Yes
Courtesy Clerk
237
Yes
Bakery Clerk
75
Yes
Pharmacy Member
87
Yes
Drug Clerk
1,387
Yes
Candy Clerk
32
Yes
Liquor Clerk
2
Yes
Utility Clerk
28
Yes
GMC (General Merchandise Clerk)
794
Yes
Cigar Clerk
2
Yes
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
DETAILED SUMMARY PAGE
- SCHEDULES 14 THROUGH 19
FILE NUMBER:
024-068
SCHEDULE 14 OTHER RECEIPTS
1. Named Payer
Itemized Receipts
$114,444
2. Named Payer
Non-itemized Receipts
$45,054
3. All Other Receipts
$5,987
4. Total
Receipts
$165,485
SCHEDULE 17 CONTRIBUTIONS,
GIFTS & GRANTS
1. Named Payee
Itemized Disbursements
$5,250
2. Named Payee
Non-itemized Disbursements
$0
3. To Officers
$3,739
4. To Employees
$0
5. All Other
Disbursements
$6,551
6. Total
Disbursements
$15,540
SCHEDULE 15 REPRESENTATIONAL
ACTIVITIES
1. Named Payee
Itemized Disbursements
$0
2. Named Payee
Non-itemized Disbursements
$72,814
3. To Officers
$471,240
4. To Employees
$197,569
5. All Other
Disbursements
$24,797
6. Total
Disbursements
$766,420
SCHEDULE 18 GENERAL OVERHEAD
1. Named Payee
Itemized Disbursements
$21,750
2. Named Payee
Non-itemized Disbursements
$87,128
3. To Officers
$61,943
4. To Employees
$163,463
5. All Other
Disbursements
$69,609
6. Total
Disbursements
$403,893
SCHEDULE 16 POLITICAL
ACTIVITIES AND LOBBYING
1. Named Payee
Itemized Disbursements
$0
2. Named Payee
Non-itemized Disbursements
$0
3. To Officers
$9,193
4. To Employees
$7,657
5. All Other
Disbursements
$300
6. Total
Disbursements
$17,150
SCHEDULE 19 UNION
ADMINISTRATION
1. Named Payee
Itemized Disbursements
$0
2. Named Payee
Non-itemized Disbursements
$0
3. To Officers
$29,633
4. To Employees
$6,631
5. All Other
Disbursements
$1,008
6. Total
Disbursements
$37,272
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 14 - OTHER
RECEIPTS
FILE NUMBER:
024-068
Name and Address
(A)
UFCW & EMPLOYER TRUSTS, LLC
1000 BURNETT AVE CONCORD CA 94520
Type or Classification
(B)
TRUST FUNDS
Purpose
(C)
Date
(D)
Amount
(E)
Total
Itemized Transactions with this Payee/Payer
$87,607
Total
Non-Itemized Transactions with this Payee/Payer
$37,894
Total of All Transactions with this
Payee/Payer for This Schedule
$125,501
Reimbursement from Trust Fd
12/31/2015
$4,820
Reimbursement from Trust Fd
01/31/2016
$4,820
Reimbursement from Trust Fd
02/29/2016
$6,140
Reimbursement from Trust Fd
03/31/2016
$18,467
Reimbursement from Trust Fd
04/30/2016
$9,369
Reimbursement from Trust Fd
05/31/2016
$9,369
Reimbursement from Trust Fd
06/30/2016
$9,369
Reimbursement from Trust Fd
07/31/2015
$5,973
Reimbursement from Trust Fd
08/31/2015
$4,820
Reimbursement from Trust Fd
09/30/2015
$4,820
Reimbursement from Trust Fd
10/31/2015
$4,820
Reimbursement from Trust Fd
11/30/2015
$4,820
Name and Address
(A)
UFCW INTERNATIONAL UNION PO BOX 17504
BALTIMORE MD 21279-1504
Type or Classification
(B)
INTERNATIONAL UNION
Purpose
(C)
Date
(D)
Amount
(E)
Total
Itemized Transactions with this Payee/Payer
$26,837
Total
Non-Itemized Transactions with this Payee/Payer
$7,160
Total of All Transactions with this
Payee/Payer for This Schedule
$33,997
Reimbursement from Int'l
03/31/2016
$15,637
Reimbursement from Int'l
05/31/2016
$5,600
Reimbursement from Int'l
06/30/2016
$5,600
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 15 -
REPRESENTATIONAL ACTIVITIES
FILE NUMBER:
024-068
Name and Address
(A)
DAVIS RENO ATTORNEYS AT LAW
22 BATTERY ST SAN FRANCISCO CA 94111
Type or Classification
(B)
LEGAL COUNSEL
Purpose
(C)
Date
(D)
Amount
(E)
Total
Itemized Transactions with this Payee/Payer
$0
Total
Non-Itemized Transactions with this Payee/Payer
$32,503
Total of All Transactions with this
Payee/Payer for This Schedule
$32,503
Name and Address
(A)
JWJ SAN FRANCISCO BAY AREA
209 GOLDEN GATE AVE SAN FRANCISCO CA 94102
Type or Classification
(B)
STRATEGIC ORGANIZER
Purpose
(C)
Date
(D)
Amount
(E)
Total
Itemized Transactions with this Payee/Payer
$0
Total
Non-Itemized Transactions with this Payee/Payer
$5,250
Total of All Transactions with this
Payee/Payer for This Schedule
$5,250
Name and Address
(A)
NEOFUNDS BY NEOPOST PO BOX 30193
TAMPA FL 33630-3193
Type or Classification
(B)
POSTAGE
Purpose
(C)
Date
(D)
Amount
(E)
Total
Itemized Transactions with this Payee/Payer
$0
Total
Non-Itemized Transactions with this Payee/Payer
$5,000
Total of All Transactions with this
Payee/Payer for This Schedule
$5,000
Name and Address
(A)
WEINBERG, ROGER & ROSENFELD
1001 MARINA VILLAGE PKWY ALAMEDA CA 94501-1091
Type or Classification
(B)
LEGAL COUNSEL
Purpose
(C)
Date
(D)
Amount
(E)
Total
Itemized Transactions with this Payee/Payer
Total
Non-Itemized Transactions with this Payee/Payer
$30,061
Total of All Transactions with this
Payee/Payer for This Schedule
$30,061
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 16 -
POLITICAL ACTIVITIES AND LOBBYING
FILE NUMBER
024-068
There was no data
found for this schedule.
SCHEDULE 17 -
CONTRIBUTIONS, GIFTS & GRANTS
FILE NUMBER:
024-068
Name and Address
(A)
LEUKEMIA & LYMPHOMA SOCIETY
221 MAIN ST STE 1650 SAN FRANCISCO CA 94105
Type or Classification
(B)
Charity
Purpose
(C)
Date
(D)
Amount
(E)
Total
Itemized Transactions with this Payee/Payer
$5,250
Total
Non-Itemized Transactions with this Payee/Payer
Total of All Transactions with this
Payee/Payer for This Schedule
$5,250
DONATION TO LEUKEMIA & LYMPHOMA SOCIETY
09/17/2015
$5,250
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 18 - GENERAL
OVERHEAD
FILE NUMBER:
024-068
Name and Address
(A)
BAYSIDE PRINTED PRODUCTS
430 N Canal St Unit 9 South San Francisco CA 94080
Type or Classification
(B)
PRINTER
Purpose
(C)
Date
(D)
Amount
(E)
Total
Itemized Transactions with this Payee/Payer
Total
Non-Itemized Transactions with this Payee/Payer
$16,059
Total of All Transactions with this
Payee/Payer for This Schedule
$16,059
Name and Address
(A)
DE LAGE LANDEN PO BOX 41602
PHILADELPHIA PA 19101-1602
Type or Classification
(B)
COPIER LEASE
Purpose
(C)
Date
(D)
Amount
(E)
Total
Itemized Transactions with this Payee/Payer
$0
Total
Non-Itemized Transactions with this Payee/Payer
$7,638
Total of All Transactions with this
Payee/Payer for This Schedule
$7,638
Name and Address
(A)
HEARTLAND PAYMENT SYSTEMS
1 HEARTLAND WAY JEFFERSONVILLE IN 47130
Type or Classification
(B)
CREDIT CARD PROCESSOR
Purpose
(C)
Date
(D)
Amount
(E)
Total
Itemized Transactions with this Payee/Payer
$0
Total
Non-Itemized Transactions with this Payee/Payer
$30,372
Total of All Transactions with this
Payee/Payer for This Schedule
$30,372
Name and Address
(A)
MILLER KAPLAN ARASE LLP
4123 LANKERSHIM BLVD NORTH HOLLYWOOD CA 91602-2828
Type or Classification
(B)
CPA
Purpose
(C)
Date
(D)
Amount
(E)
Total
Itemized Transactions with this Payee/Payer
$21,750
Total
Non-Itemized Transactions with this Payee/Payer
$0
Total of All Transactions with this
Payee/Payer for This Schedule
$21,750
Audit and Tax Returns
11/05/2015
$8,415
Audit and Tax Returns
06/03/2016
$13,335
Name and Address
(A)
SONIC.NET, INC
2260 APOLLO WAY SANTA ROSA CA 95407
Type or Classification
(B)
TELEPHONE PROVIDER
Purpose
(C)
Date
(D)
Amount
(E)
Total
Itemized Transactions with this Payee/Payer
$0
Total
Non-Itemized Transactions with this Payee/Payer
$12,999
Total of All Transactions with this
Payee/Payer for This Schedule
$12,999
Name and Address
(A)
U.S. POSTMASTER
3540 W LINCOLN ST PHOENIX AZ 85009
Type or Classification
(B)
POSTAGE
Purpose
(C)
Date
(D)
Amount
(E)
Total
Itemized Transactions with this Payee/Payer
$0
Total
Non-Itemized Transactions with this Payee/Payer
$11,500
Total of All Transactions with this
Payee/Payer for This Schedule
$11,500
Name and Address
(A)
UNION AUTOMATION PO Box 3356
NAPA CA 94558
Type or Classification
(B)
COMPUTER CONSULTING
Purpose
(C)
Date
(D)
Amount
(E)
Total
Itemized Transactions with this Payee/Payer
$0
Total
Non-Itemized Transactions with this Payee/Payer
$8,560
Total of All Transactions with this
Payee/Payer for This Schedule
$8,560
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 19 - UNION
ADMINISTRATION
FILE NUMBER:
024-068
There was no data
found for this schedule.
SCHEDULE 20 -
BENEFITS
FILE NUMBER:
024-068
Description
(A)
To Whom Paid
(B)
Amount
(C)
Total of all
lines above (Total will be automatically entered in Item
55.)
$283,820
PENSION CONTRIBUTIONS
MULTIEMPLOYER TRUST PENSION PLANS
$67,954
HEALTH CONTRIBUTIONS
MULTIEMPLOYER TRUST HEALTH PLANS
$200,250
WORKERS' COMPENSATION INSURANCE
INSURANCE CARRIER
$15,616
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
69. ADDITIONAL
INFORMATION SUMMARY
FILE NUMBER:
024-068
Question 11(a):
Question 11(a): : : United Food and Commercial Workers Local 648 PAC Fund, EIN 51-0449851. The PAC fund files with Secretary of State, Political Reform Division, Los Angeles County Registrar - Recorder, City and County of San Francisco.
Question 12: AN AUDIT OF THE BOOKS AND RECORDS WAS PERFORMED BY AN INDEPENDENT ACCOUNTING FIRM, MILLER KAPLAN ARASE LLP, 44 MONTGOMERY STREET, SUITE 3701, SAN FRANCISCO, CA 94104-4831, (415) 956-3600.
Question 17: Vacation Benefits - Current Employees - certain current employees of the Local Union earn vacation benefits. The estimated liability for vacation benefits as of June 30, 2016 is approximately $173,000.
Question 10: UFCW- Northern California Employers Pension Plan- EIN 94-6313554; Plan No.001- Provides pension benefits- PO Box 4102, Concord, CA 94524-4102 Northern California Pharmacists Clerks and Drug Employers Pension Fund- EIN 94-6313555; Plan No. 001- Provides retirement benefits- PO Box 8082, Concord, CA 94524-8082 Walgreen Company & Local 648 Welfare Trust Fund- EIN 94-3087852; Plan No. 501- Provides medical, dental and vision benefits- 1640 S Loop Road, Alameda, CA 94502-7089 UFCW- Northern California Food Employers Joint Individual Account Pension Plan- EIN 68-0161773; Plan No. 002- Provides benefits upon retirement, death, total disability or job termination- PO Box 4102, Concord, CA 94524-4102 UFCW & Employers Benefit Fund- EIN 94-6078804; Plan No. 501- Provides medical, dental prescription drug, vision, Member assistance Program, sick leave and death benefits- PO Box 4100, Concord, CA 94524-4100 Retail Clerks Specialty Stores Pension Plan- EIN 94-2518316; Plan No. 001- Provides retirement benefits- PO Box 8082, Concord, CA 94524-8082
Schedule 13, Row3:Bakery clerk member working as a cashier/stocker in an independent bakery - full dues.
Schedule 13, Row1:Food clerk member working as a cashier/stocker in a grocery store - full dues.
Schedule 13, Row2:Courtesy clerk member working as a bagger in a grocery store - full dues.
Schedule 13, Row4:Pharmacy member working as a pharmacist filling prescriptions - full dues.
Schedule 13, Row5:Drug clerk member working as a cashier/stocker working in a drug store - full dues.
Schedule 13, Row6:Candy clerk member working as a cashier/stocker in a candy store - full dues.
Schedule 13, Row7:Liquor clerk member working as a cashier/stocker in a liquor store - full dues.
Schedule 13, Row8:Utility clerk member performing warehouse duties as well as a cashier - full dues.
Schedule 13, Row9:GMC member working in the deli/floral/bakery in a grocery store - full dues.
Schedule 13, Row10:Cigar clerk member working as a cashier/stocker in a cigar store - full dues.