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
From07/01/2015
Through06/30/2016
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 LARSONPRESIDENT71. SIGNED:Milton HumTREASURER
Date:Oct 04, 2016Telephone Number:415-861-7840Date:Oct 04, 2016Telephone 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/FeesAmount UnitMinimumMaximum
(a) Regular Dues/Fees$33.50-$42.50perMonth$33.50$42.50
(b) Working Dues/FeesN/AperN/AN/AN/A
(c) Initiation Fees$210-$350perInitiation$210$350
(d) Transfer FeesN/AperN/AN/AN/A
(e) Work PermitsN/AperN/AN/AN/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 Receivable1$0
24. Loans Receivable2
25. U.S. Treasury Securities $0$0
26. Investments5$859,656$870,476
27. Fixed Assets6$310,562$273,789
28. Other Assets7$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 Payable8
31. Loans Payable9
32. Mortgages Payable $0$0
33. Other Liabilities10$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 RECEIPTSSCHAMOUNT
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 Assets3
44. Loans Obtained9
45. Repayments of Loans Made2
46. On Behalf of Affiliates for Transmittal to Them $0
47. From Members for Disbursement on Their Behalf $0
48. Other Receipts14$165,485
49. TOTAL RECEIPTS $2,413,636
CASH DISBURSEMENTSSCHAMOUNT
50. Representational Activities15$766,420
51. Political Activities and Lobbying16$17,150
52. Contributions, Gifts, and Grants17$15,540
53. General Overhead18$403,893
54. Union Administration19$37,272
55. Benefits20$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 Assets4$4,347
61. Loans Made2
62. Repayment of Loans Obtained9
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 61Item 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 44Item 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 Payers3,758 
*Agency Fee Payers are not considered members of the labor organization.
Food Clerk1,111Yes
Courtesy Clerk237Yes
Bakery Clerk75Yes
Pharmacy Member87Yes
Drug Clerk1,387Yes
Candy Clerk32Yes
Liquor Clerk2Yes
Utility Clerk28Yes
GMC (General Merchandise Clerk)794Yes
Cigar Clerk2Yes
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 Fd12/31/2015$4,820
Reimbursement from Trust Fd01/31/2016$4,820
Reimbursement from Trust Fd02/29/2016$6,140
Reimbursement from Trust Fd03/31/2016$18,467
Reimbursement from Trust Fd04/30/2016$9,369
Reimbursement from Trust Fd05/31/2016$9,369
Reimbursement from Trust Fd06/30/2016$9,369
Reimbursement from Trust Fd07/31/2015$5,973
Reimbursement from Trust Fd08/31/2015$4,820
Reimbursement from Trust Fd09/30/2015$4,820
Reimbursement from Trust Fd10/31/2015$4,820
Reimbursement from Trust Fd11/30/2015$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'l03/31/2016$15,637
Reimbursement from Int'l05/31/2016$5,600
Reimbursement from Int'l06/30/2016$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 SOCIETY09/17/2015$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 Returns11/05/2015$8,415
Audit and Tax Returns06/03/2016$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 CONTRIBUTIONSMULTIEMPLOYER TRUST PENSION PLANS$67,954
HEALTH CONTRIBUTIONSMULTIEMPLOYER TRUST HEALTH PLANS$200,250
WORKERS' COMPENSATION INSURANCEINSURANCE 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.
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)