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: 09-30-2021
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
069-941
2. PERIOD COVERED
From10/01/2018
Through09/30/2019
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
UNION OF AMERICAN PHYSICIANS
5. DESIGNATION (Local, Lodge, etc.)
STATE FEDERATION
6. DESIGNATION NBR

7. UNIT NAME (if any)
CALIFORNIA FEDERATION OF THE UNION OF AMERICAN
8. MAILING ADDRESS (Type or print in capital letters)
First Name
STUART
Last Name
BUSSEY
P.O Box - Building and Room Number

Number and Street
520 CAPITOL MALL, SUITE 220
City
SACRAMENTO
State
CA
ZIP Code + 4
95814


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:stuart A BusseyPRESIDENT71. SIGNED:Victoria BehrmanTREASURER
Date:Dec 26, 2019Telephone Number:510-839-0193Date:Dec 26, 2019Telephone Number:916-442-6977
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
ITEMS 10 THROUGH 21 FILE NUMBER: 069-941
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?No
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?$1,000,000
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?No
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?09/2021
20. How many members did the labor organization have at the end of the reporting period?2,900
21. What are the labor organization's rates of dues and fees?
Rates of Dues and Fees
Dues/FeesAmount UnitMinimumMaximum
(a) Regular Dues/Fees$440perYear$72.00$3385.00
(b) Working Dues/Feesper
(c) Initiation Feesper
(d) Transfer Feesper
(e) Work Permitsper

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
STATEMENT A - ASSETS AND LIABILITIES FILE NUMBER: 069-941

ASSETS
ASSETS Schedule
Number
Start of Reporting Period
(A)
End of Reporting Period
(B)
22. Cash $8,170,050$9,253,270
23. Accounts Receivable1$0$0
24. Loans Receivable2$0$0
25. U.S. Treasury Securities $0$0
26. Investments5$0$0
27. Fixed Assets6$0$0
28. Other Assets7$0$0
29. TOTAL ASSETS $8,170,050$9,253,270

LIABILITIES
LIABILITIES Schedule
Number
Start of Reporting Period
(A)
End of Reporting Period
(B)
30. Accounts Payable8$0$0
31. Loans Payable9$0$0
32. Mortgages Payable $0$0
33. Other Liabilities10$0$0
34. TOTAL LIABILITIES $0$0
35. NET ASSETS$8,170,050$9,253,270
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
STATEMENT B - RECEIPTS AND DISBURSEMENTS FILE NUMBER: 069-941

CASH RECEIPTSSCHAMOUNT
36. Dues and Agency Fees $5,817,030
37. Per Capita Tax $0
38. Fees, Fines, Assessments, Work Permits $0
39. Sale of Supplies $0
40. Interest $195,289
41. Dividends $0
42. Rents $0
43. Sale of Investments and Fixed Assets3$0
44. Loans Obtained9$0
45. Repayments of Loans Made2$0
46. On Behalf of Affiliates for Transmittal to Them $0
47. From Members for Disbursement on Their Behalf $0
48. Other Receipts14$0
49. TOTAL RECEIPTS $6,012,319
CASH DISBURSEMENTSSCHAMOUNT
50. Representational Activities15$1,589,247
51. Political Activities and Lobbying16$425,020
52. Contributions, Gifts, and Grants17$0
53. General Overhead18$2,228,672
54. Union Administration19$204,571
55. Benefits20$481,589
56. Per Capita Tax $0
57. Strike Benefits $0
58. Fees, Fines, Assessments, etc. $0
59. Supplies for Resale $0
60. Purchase of Investments and Fixed Assets4$0
61. Loans Made2$0
62. Repayment of Loans Obtained9$0
63. To Affiliates of Funds Collected on Their Behalf $0
64. On Behalf of Individual Members $0
65. Direct Taxes $0
  
66. Subtotal $4,929,099
67. Withholding Taxes and Payroll Deductions  
  67a. Total Withheld$624,930  
  67b. Less Total Disbursed$624,930  
  67c. Total Withheld But Not Disbursed 
68. TOTAL DISBURSEMENTS $4,929,099
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 1 - ACCOUNTS RECEIVABLE AGING SCHEDULE FILE NUMBER: 069-941

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$0$0$0$0
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: 069-941

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$0$0$0$0$0
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: 069-941

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$0
(The total from Net Sales Line will be automatically entered in Item 43)Net Sales$0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 4 - PURCHASE OF INVESTMENTS AND FIXED ASSETS FILE NUMBER: 069-941

Description (if land or buildings, give location)
(A)
Cost
(B)
Book Value
(C)
Cash Paid
(D)
Total of all lines above$0$0$0
 Less Reinvestments$0
(The total from Net Purchases Line will be automatically entered in Item 60.)Net Purchases$0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 5 - INVESTMENTS FILE NUMBER: 069-941

Description
(A)
Amount
(B)
Marketable Securities 
A. Total Cost
B. Total Book Value
C. List each marketable security which has a book value over $5,000 and exceeds 5% of Line B.  
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)) $0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 6 - FIXED ASSETS FILE NUMBER: 069-941

Description
(A)
Cost or Other Basis
(B)
Total Depreciation or
Amount Expensed
(C)
Book Value
(D)
Value
(E)
A. Land (give location)$0 $0$0
B. Buildings (give location)$0$0$0$0
C. Automobiles and Other Vehicles
D. Office Furniture and Equipment
E. Other Fixed Assets$0$0$0$0
F. Totals of Lines A through E (Column(D) Total will be automatically entered in Item 27, Column(B)) $0$0$0$0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 7 - OTHER ASSETS FILE NUMBER: 069-941

Description
(A)
Book Value
(B)
Total (Total will be automatically entered in Item 28, Column(B)) $0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 8 - ACCOUNTS PAYABLE AGING SCHEDULE FILE NUMBER: 069-941

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: 069-941

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: 069-941

Description
(A)
Amount at End of Period
(B)
Total Other Liabilities (Total will be automatically entered in Item 33, Column(D)) $0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 11 - ALL OFFICERS AND DISBURSEMENTS TO OFFICERS FILE NUMBER: 069-941

(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
Bussey ,  Stuart   A
President
C
$0$0$0$0
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Lewis ,  Ronald  
Vice President
C
$0$4,076$0$4,076
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Farooqi ,  Mubashir  
Vice President
C
$0$474$0$474
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Pendurkar ,  Shakalpi  
Secretary
C
$0$0$0$0
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Statti ,  Peter  
Treasurer
P
$0$223$0$223
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Behrman ,  Victoria  
Treasurer
C
$0$2,316$0$2,316
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Lorig ,  Milton  
Board Member
C
$0$488$0$488
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Nelson ,  Jeff  
Board Member
C
$0$1,561$0$1,561
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Bitonte ,  Robert  
Board Member
C
$0$0$0$0
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Cheng ,  Rex  
Board Member
C
$0$857$0$857
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Pedneault ,  Gary  
Board Member
C
$0$3,129$0$3,129
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Radhakrishnan ,  Sandhya  
Board Member
C
$0$0$0$0
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Spinoso ,  Alex  
board Member
C
$0$402$0$402
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Uyanne ,  John  
Board Member
C
$0$0$0$0
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Jackson ,  Daniel  
Board Member
N
$0$0$0$0
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Wartena ,  Erica  
Board Member
C
$0$0$0$0
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
Total Officer Disbursements$0$0$13,526$0$13,526
Less Deductions     
Net Disbursements    $13,526
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 12 - DISBURSEMENTS TO EMPLOYEES FILE NUMBER: 069-941

(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
Adams ,  Indya  
Rep/Organizer
C
$75,000$3,066$9,248$87,314
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Alexander ,  Cheryl  
Finance and Benefits Mgr
C
$102,932$676$0$103,608
I
Schedule 15
Representational Activities
Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
80 % Schedule 19
Administration
20 %
A
B
C
Anderson ,  Laura  
Chief Negotiator
P
$16,702$0$0$16,702
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
lBaldovinos ,  Nancy  
Office Manaager
C
$77,800$0$11,625$89,425
I
Schedule 15
Representational Activities
Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
90 % Schedule 19
Administration
10 %
A
B
C
Baxter ,  Andrew  
Sr. Rep/Organizer
C
$112,856$6,447$119,303
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Bussey ,  Stuart  
President
C
$192,333$19,229$0$211,562
I
Schedule 15
Representational Activities
20 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
60 % Schedule 19
Administration
20 %
A
B
C
Chiappetta ,  R Douglas  
Executive Director
C
$163,893$7,017$11,758$182,668
I
Schedule 15
Representational Activities
20 % Schedule 16
Political Activities and Lobbying
20 % Schedule 17
Contributions
Schedule 18
General Overhead
40 % Schedule 19
Administration
20 %
A
B
C
Cordova ,  Christine  
Program Specialist
C
$73,333$200$0$73,533
I
Schedule 15
Representational Activities
Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
100 % Schedule 19
Administration
A
B
C
Crane ,  Joseph  
Regional Administrator
C
$101,250$10,895$6,607$118,752
I
Schedule 15
Representational Activities
90 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
0 % Schedule 19
Administration
10 %
A
B
C
Diel ,  John  
Chief Negotiator
P
$93,722$3,108$3,870$100,700
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Duarte ,  Gloria  
Office Manager
C
$106,173$197$28,735$135,105
I
Schedule 15
Representational Activities
Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
80 % Schedule 19
Administration
20 %
A
B
C
Dunn ,  Laurel  
Communications Specialist
C
$54,451$0$0$54,451
I
Schedule 15
Representational Activities
Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
100 % Schedule 19
Administration
A
B
C
Evans ,  Bryan  
Sr. Rep/Organizer
N
$13,750$2,516$16,266
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Ford-Lewis ,  Lisa  
Representative
C
$80,026$5,850$11,817$97,693
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Golden-Ortiz ,  Glynnis  
Sr. Representative
C
$102,703$5,002$10,228$117,933
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Groh ,  Albert  
Consultant
C
$748$32$0$780
I
Schedule 15
Representational Activities
Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
100 % Schedule 19
Administration
A
B
C
Hanley ,  Gabrielle  
Organizer
C
$71,875$3,934$4,841$80,650
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Hernandez ,  Patricia  
Sr.Representative
C
$137,367$7,569$1,659$146,595
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Ige ,  Christopher  
Regional Administrator
C
$117,520$5,656$5,125$128,301
I
Schedule 15
Representational Activities
90 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
10 %
A
B
C
Irvin ,  Lux  
Sr. Representative
P
$12,115$1,422$0$13,537
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Jenkins ,  Timothy  
Sr. Rep/Organizer
C
$112,640$4,211$5,332$122,183
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Leonard ,  Robert  
Sr. Representative
N
$18,333$2,123$0$20,456
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Lester ,  Charles  
Regional Administrator
P
$68,779$708$10$69,497
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Modrall ,  Claudia  
Private Practice Asst.
C
$73,669$49$0$73,718
I
Schedule 15
Representational Activities
Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
90 % Schedule 19
Administration
10 %
A
B
C
Mohammed ,  Adrian  
Leg. Liasion/Rep
C
$75,000$4,147$8,374$87,521
I
Schedule 15
Representational Activities
50 % Schedule 16
Political Activities and Lobbying
50 % Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Munoz ,  Albert  
Sr. Representative
P
$21,386$1,083$3,060$25,529
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Rivera ,  Nereyda  
Sr. Representative
C
$128,217$18,100$0$146,317
I
Schedule 15
Representational Activities
100 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
A
B
C
Robinson ,  Gary  
Consultant
C
$41,027$2,923$0$43,950
I
Schedule 15
Representational Activities
80 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
20 %
A
B
C
Snipes ,  Carolyns  
Office Manager
P
$59,490$0$1,714$61,204
I
Schedule 15
Representational Activities
Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
80 % Schedule 19
Administration
20 %
A
B
C
Tovar ,  Paula  
Administrative Assistant
N
$10,000$0$0$10,000
I
Schedule 15
Representational Activities
0 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
90 % Schedule 19
Administration
10 %
A
B
C
Williams ,  Zegory  
Executive Direcctor
P
$69,049$1,006$4,601$74,656
I
Schedule 15
Representational Activities
20 % Schedule 16
Political Activities and Lobbying
Schedule 17
Contributions
Schedule 18
General Overhead
60 % Schedule 19
Administration
20 %
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$2,384,139$0$117,166$128,604$2,629,909
Less Deductions     
Net Disbursements    $2,629,909
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 13 - MEMBERSHIP STATUS FILE NUMBER: 069-941

Category of Membership
(A)
Number
(B)
Voting Eligibility
(C)
Members (Total of all lines above) 2,900 
Agency Fee Payers*10
Total Members/Fee Payers2,910 
*Agency Fee Payers are not considered members of the labor organization.
State Employed Members900Yes
County Employed Members1,900Yes
Private Practice Members100Yes
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
DETAILED SUMMARY PAGE - SCHEDULES 14 THROUGH 19 FILE NUMBER: 069-941

SCHEDULE 14   OTHER RECEIPTS
1. Named Payer Itemized Receipts$0
2. Named Payer Non-itemized Receipts$0
3. All Other Receipts$0
4. Total Receipts$0
     
     
SCHEDULE 17   CONTRIBUTIONS, GIFTS & GRANTS
1. Named Payee Itemized Disbursements$0
2. Named Payee Non-itemized Disbursements$0
3. To Officers$0
4. To Employees$0
5. All Other Disbursements$0
6. Total Disbursements$0
SCHEDULE 15   REPRESENTATIONAL ACTIVITIES
1. Named Payee Itemized Disbursements$0
2. Named Payee Non-itemized Disbursements$0
3. To Officers$13,526
4. To Employees$1,575,721
5. All Other Disbursements
6. Total Disbursements$1,589,247
SCHEDULE 18   GENERAL OVERHEAD
1. Named Payee Itemized Disbursements$864,414
2. Named Payee Non-itemized Disbursements$382,932
3. To Officers$0
4. To Employees$769,324
5. All Other Disbursements$212,002
6. Total Disbursements$2,228,672
SCHEDULE 16   POLITICAL ACTIVITIES AND LOBBYING
1. Named Payee Itemized Disbursements$332,309
2. Named Payee Non-itemized Disbursements$12,416
3. To Officers$0
4. To Employees$80,295
5. All Other Disbursements
6. Total Disbursements$425,020
SCHEDULE 19   UNION ADMINISTRATION
1. Named Payee Itemized Disbursements$0
2. Named Payee Non-itemized Disbursements$0
3. To Officers$0
4. To Employees$204,571
5. All Other Disbursements
6. Total Disbursements$204,571
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 14 - OTHER RECEIPTS FILE NUMBER: 069-941

Name and Address
(A)




-1
Type or Classification
(B)
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer 
Total of All Transactions with this Payee/Payer for This Schedule$0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 15 - REPRESENTATIONAL ACTIVITIES FILE NUMBER: 069-941

Name and Address
(A)




-1
Type or Classification
(B)
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer 
Total of All Transactions with this Payee/Payer for This Schedule$0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 16 - POLITICAL ACTIVITIES AND LOBBYING FILE NUMBER 069-941

Name and Address
(A)
AFSCME PEOPLE Qualified Committee

1625 L Street, N.W.
Washington
DC
20036
Type or Classification
(B)
AFSCME Qualified PAC Fund
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer$5,826
Total of All Transactions with this Payee/Payer for This Schedule$5,826
Name and Address
(A)
UAPD I.E. PAC
c/o Olson Hagel Fishburn
555 Capital Mall, Ste. 1425
Sacramento
CA
Type or Classification
(B)
UAPD I.E. PAC
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer$55,115
Total Non-Itemized Transactions with this Payee/Payer$6,590
Total of All Transactions with this Payee/Payer for This Schedule$61,705
I.E. Expenditures01/25/2019$5,740
I.E. Expenditures02/28/2019$5,660
I.E. Expenditures03/31/2019$5,645
I.E. Expenditures04/30/2019$5,805
I.E. Expenditures05/31/2019$5,785
I.E. Expenditures06/30/2019$6,010
I.E. Expenditures07/26/2019$6,410
I.E. Expenditures08/30/2019$6,650
I.E. Expenditures09/30/2019$7,410
Name and Address
(A)
UAPD Small ContributorCommittee
c/o Olson Hagel Fishburn
555 Capital Mall, Ste. 400
Sacramento
CA
95814
Type or Classification
(B)
UAPD Small Contributor Committee
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer$277,194
Total Non-Itemized Transactions with this Payee/Payer 
Total of All Transactions with this Payee/Payer for This Schedule$277,194
UAPD PAC10/26/2018$19,908
UAPD PAC11/30/2018$20,622
UAPD PAC12/31/2018$18,648
UAPC PAC01/31/2019$24,107
UAPD PAC02/28/2019$23,640
UAPD PAC03/31/2019$23,706
UAPD PAC04/30/2019$23,774
UAPD PAC05/31/2019$23,682
UAPD PAC06/30/2019$23,897
UAPD PAC07/31/2019$24,447
UAPD PAC08/31/2019$24,900
UAPD PAC09/30/2019$25,863
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 17 - CONTRIBUTIONS, GIFTS & GRANTS FILE NUMBER: 069-941

Name and Address
(A)




-1
Type or Classification
(B)
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer 
Total of All Transactions with this Payee/Payer for This Schedule$0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 18 - GENERAL OVERHEAD FILE NUMBER: 069-941

Name and Address
(A)
ABM Parking Services

1960 E. Grand Avenue
El Segundo
CA
90245
Type or Classification
(B)
Parking for LA Office
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer$14,323
Total of All Transactions with this Payee/Payer for This Schedule$14,323
Name and Address
(A)
AFSCME AFL-CIO Per Cap

1625 L Street, N.W.
Washington
DC
20036
Type or Classification
(B)
Union Affiliate Per Cap Dues/Fees
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer$425,100
Total Non-Itemized Transactions with this Payee/Payer 
Total of All Transactions with this Payee/Payer for This Schedule$425,100
Per Capita10/26/2018$33,599
Per Capita11/30/2018$34,235
Per Capita12/31/2018$35,105
Per Capita01/31/2019$35,036
Per Capita02/28/2019$34,664
Per Capita03/31/2019$35,691
Per Capita04/30/2019$34,102
Per Capita05/31/2019$35,473
Per Capita06/30/2019$36,037
Per Capita07/31/2019$36,398
Per Capita08/31/2019$36,517
Per Capita09/30/2019$38,243
Name and Address
(A)
AmTrust North America
P.O. Box 6939

Cleveland
OH
44101
Type or Classification
(B)
Workers Comp Insurance
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer$21,610
Total Non-Itemized Transactions with this Payee/Payer$36,432
Total of All Transactions with this Payee/Payer for This Schedule$58,042
WKC Installment04/12/2019$11,877
WKC Installment09/13/2019$9,733
Name and Address
(A)
Apple One
P.O. Box 29048

Glendale
CA
91209
Type or Classification
(B)
Extra Help - Clerical
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer$6,000
Total Non-Itemized Transactions with this Payee/Payer$27,726
Total of All Transactions with this Payee/Payer for This Schedule$33,726
Temporary Employee Buyout07/26/2019$6,000
Name and Address
(A)
BCT Consulting, Inc.

440 W. Fallbrook
Fresno
CA
93711
Type or Classification
(B)
Telephone Lease for Sacramento Office
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer$6,327
Total of All Transactions with this Payee/Payer for This Schedule$6,327
Name and Address
(A)
BSREP II Office Holding II LLC
P.O. Box 847386
1600 S. Sherbourne Drive
Los Angeles
CA
90084
Type or Classification
(B)
Lease payments for the El Segundo Office
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer$149,079
Total Non-Itemized Transactions with this Payee/Payer 
Total of All Transactions with this Payee/Payer for This Schedule$149,079
Los Angeles Rent10/01/2018$11,630
Los Angeles Rent11/01/2018$11,630
Los Angeles Rent12/01/2018$11,630
Los Angeles Rent01/01/2019$12,534
Los Angeles Rent02/01/2019$12,523
Los Angeles Rent03/01/2019$12,523
Los Angeles Rent04/01/2019$13,274
Los Angeles Rent05/01/2019$13,397
Los Angeles Rent06/01/2019$12,523
Los Angeles Rent07/01/2019$12,253
Los Angeles Rent08/01/2019$12,523
Los Angeles Rent09/01/2019$12,639
Name and Address
(A)
Coalition of County Unions

2 Cupania Circle
Monterey Park
CA
91750
Type or Classification
(B)
Legal Services
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer$13,286
Total of All Transactions with this Payee/Payer for This Schedule$13,286
Name and Address
(A)
Comcast
P.O. Box 34744
18 West Mercer St, Ste. 400
Seattle
WA
98124
Type or Classification
(B)
Computer Access
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer$7,858
Total of All Transactions with this Payee/Payer for This Schedule$7,858
Name and Address
(A)
Cousins Holdings, LLC

40400 Harts Lake Valley Roa
Roy
WA
98580
Type or Classification
(B)
Lease payments for the Tacoma, WA payments
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer$23,950
Total of All Transactions with this Payee/Payer for This Schedule$23,950
Name and Address
(A)
Easy Permit
P.O. Box 371874

Pittsburgh
PA
15250
Type or Classification
(B)
Mailing/Postage
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer$7,151
Total of All Transactions with this Payee/Payer for This Schedule$7,151
Name and Address
(A)
First Repubic Investments

111 Pine Street
San Francisco
CA
94111
Type or Classification
(B)
Bank Charges
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer$50,721
Total Non-Itemized Transactions with this Payee/Payer 
Total of All Transactions with this Payee/Payer for This Schedule$50,721
Bank Charges10/31/2018$12,710
Bank Charges01/31/2019$12,208
Bank Charges04/30/2019$12,763
Bank Charges07/31/2019$13,040
Name and Address
(A)
Golden Gate Print & Media Services

11144 Golf Links Road
Oakland
CA
94605
Type or Classification
(B)
Printing Company
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer$17,582
Total of All Transactions with this Payee/Payer for This Schedule$17,582
Name and Address
(A)
Hub International
P.O. Box 5076

San Ramon
CA
94583
Type or Classification
(B)
Property/Casualty Insuraces
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer$17,108
Total Non-Itemized Transactions with this Payee/Payer$2,074
Total of All Transactions with this Payee/Payer for This Schedule$19,182
Insurance Payment09/20/2019$17,108
Name and Address
(A)
James R. Mount

3967 Mead Street
Antioch
CA
94531
Type or Classification
(B)
Computer IT technician
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer$10,075
Total of All Transactions with this Payee/Payer for This Schedule$10,075
Name and Address
(A)
Jaystar Group Inc.

85 East Avenue
Norwalk
CT
06851
Type or Classification
(B)
Database System for Union
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer$5,338
Total Non-Itemized Transactions with this Payee/Payer$26,568
Total of All Transactions with this Payee/Payer for This Schedule$31,906
Database system payment07/26/2019$5,338
Name and Address
(A)
Law Offices of John Kagel
P.O. Box 50787

Palo Alto
CA
94301
Type or Classification
(B)
Legal Office for Sacramento office
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer$8,130
Total of All Transactions with this Payee/Payer for This Schedule$8,130
Name and Address
(A)
Level 3 Communications
P.O. Box 910182

Denver
CO
80291
Type or Classification
(B)
El Segundo office telephone lease
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer$6,414
Total of All Transactions with this Payee/Payer for This Schedule$6,414
Name and Address
(A)
Los Angeles County Federation
2130 W. James M. Wood Blvd

Los Angeles
CA
90006
Type or Classification
(B)
Los Angeles County Union
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer$7,407
Total of All Transactions with this Payee/Payer for This Schedule$7,407
Name and Address
(A)
Olson Hagel & Fishburn LLP

555 Capital Mall, Ste. 1425
Sacramento
CA
95814
Type or Classification
(B)
Legal PAC/Lobbyist Services
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer$20,098
Total of All Transactions with this Payee/Payer for This Schedule$20,098
Name and Address
(A)
Pitney Bowes Global Financial Services
P.O. Box 37187

Pittsburg
PA
15250
Type or Classification
(B)
Postage Machine Leases for two offices
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer$8,689
Total of All Transactions with this Payee/Payer for This Schedule$8,689
Name and Address
(A)
R. T. Capital Mall Rent for Sacramento

2870 Gateway Oaks
Sacramento
CA
95833
Type or Classification
(B)
Lease for LA Office
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer$105,401
Total Non-Itemized Transactions with this Payee/Payer$4,184
Total of All Transactions with this Payee/Payer for This Schedule$109,585
Rent for Sacramento10/01/2018$15,319
Rent for Sacramento11/01/2018$9,167
Rent for Sacramento12/01/2018$9,167
Rent for Sacramento01/01/2019$9,253
Rent for Sacramento02/01/2019$9,253
Rent for Sacramento03/01/2019$9,473
Rent for Sacramento04/01/2019$9,473
Rent for Sacramento05/01/2019$8,312
Rent for Sacramento06/01/2019$8,388
Rent for Sacramento07/01/2019$8,798
Rent for Sacramento08/01/2019$8,798
Name and Address
(A)
Scientia

838 Central Avenue
Highland Park
IL
60035
Type or Classification
(B)
Continuing Medical Education service
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer$5,800
Total of All Transactions with this Payee/Payer for This Schedule$5,800
Name and Address
(A)
TPX

5657 Copley Drive
San Diego
CA
92150
Type or Classification
(B)
Telephone Lease for El Segundo Office
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer$12,758
Total of All Transactions with this Payee/Payer for This Schedule$12,758
Name and Address
(A)
Travelers CL Remittance Center
P.O. Box 660317

Dallas
TX
75266
Type or Classification
(B)
Property/Casualty Insuraces
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer$8,761
Total of All Transactions with this Payee/Payer for This Schedule$8,761
Name and Address
(A)
US Bancorop
P.O. Box 790448

St. Louis
MO
63179
Type or Classification
(B)
Xeorx Lease for Sacramnto Office
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer$17,695
Total of All Transactions with this Payee/Payer for This Schedule$17,695
Name and Address
(A)
Valley Relocation and Storage

5000 Marsh Drive
Concord
CA
94520
Type or Classification
(B)
Relocation Company - move Oakland to Sacramento
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer$10,092
Total Non-Itemized Transactions with this Payee/Payer 
Total of All Transactions with this Payee/Payer for This Schedule$10,092
Moving Expenses10/05/2018$10,092
Name and Address
(A)
Van Sloten & Laranang CPAs

39176-B State Street
Fremont
CA
94538
Type or Classification
(B)
CPAs for Annual Audit
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer$7,324
Total Non-Itemized Transactions with this Payee/Payer$2,543
Total of All Transactions with this Payee/Payer for This Schedule$9,867
Audit Payment03/15/2019$7,324
Name and Address
(A)
Weinberg, Roger & Rosenfeld

1001 Marina Village Pkwy,
Alameda
CA
94501
Type or Classification
(B)
Legal Office for Sacramento office
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer$36,984
Total Non-Itemized Transactions with this Payee/Payer$51,703
Total of All Transactions with this Payee/Payer for This Schedule$88,687
Legal Payments10/31/2018$29,183
Legal Payments06/28/2019$7,801
Name and Address
(A)
Westin Hotel SFO

1 Old Bayshore Hwy
Millbrae
CA
94030
Type or Classification
(B)
Hotel for Triennial
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer$29,657
Total Non-Itemized Transactions with this Payee/Payer$3,512
Total of All Transactions with this Payee/Payer for This Schedule$33,169
Triennial Deposit--Amex11/09/2018$29,657
Name and Address
(A)
Xerox Corporation
P.O. Box 7405

Pasadena
CA
91109
Type or Classification
(B)
Xeorx Lease for Sacramnto Office
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer$15,943
Total of All Transactions with this Payee/Payer for This Schedule$15,943
Name and Address
(A)
Xerox Financial Services
P.O. Box 202882

Dallas
TX
75320
Type or Classification
(B)
Xerox Lease for El Segundo office
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer$15,943
Total of All Transactions with this Payee/Payer for This Schedule$15,943
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 19 - UNION ADMINISTRATION FILE NUMBER: 069-941

Name and Address
(A)




-1
Type or Classification
(B)
Purpose
(C)
Date
(D)
Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer 
Total of All Transactions with this Payee/Payer for This Schedule$0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 20 - BENEFITS FILE NUMBER: 069-941

Description
(A)
To Whom Paid
(B)
Amount
(C)
Total of all lines above (Total will be automatically entered in Item 55.)$481,589
Dental InsuranceDelta Dental$40,603
Health and Vision InsuranceWestern Alliance Trust Fund$124,436
HealthKaiser$39,570
Life InsuranceStandard Life Insurance$4,814
AFSCME PensionAFSCME Pension Plan$271,647
AFSCME Salary SavingsSavings Plan Costs$519
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
69. ADDITIONAL INFORMATION SUMMARY FILE NUMBER: 069-941


Question 12: Van Sloten & Laranang CPA, PC

Question 11(a):

Question 11(a): : UAPD - I.E. PAC UAPD - Small Contributors Fund UAPD - AFSCME PAC

Schedule 13, Row1:

Schedule 13, Row1:

Schedule 13, Row1:

Schedule 13, Row1:

Schedule 13, Row1:

Schedule 13, Row1:

Schedule 13, Row2:

Schedule 13, Row2:

Schedule 13, Row2:Counties in the State of California Doctors and Dentists

Schedule 13, Row2:

Schedule 13, Row2:

Schedule 13, Row2:

Schedule 13, Row3:

Schedule 13, Row3:

Schedule 13, Row3:State of California Private Practice Doctors and Dentists

Schedule 13, Row3:

Schedule 13, Row3:

Schedule 13, Row3:
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)