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
530-838
2.
PERIOD COVERED
From
04/01/2020
Through
03/31/2021
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
SERVICE EMPLOYEES
5. DESIGNATION (Local, Lodge, etc.)
LEADERSHIP COUNCIL
6. DESIGNATION NBR
7. UNIT NAME (if any)
OREGON SERVICE
8. MAILING ADDRESS (Type or print in capital
letters)
First Name
MIKE
Last Name
POWERS
P.O Box - Building and Room Number
Number and Street
6401 SE FOSTER ROAD
City
PORTLAND
State
OR
ZIP Code + 4
97206
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:
Michael P Powers
PRESIDENT
71. SIGNED:
Melissa S Unger
TREASURER
Date:
Jun 28, 2021
Telephone
Number:
503-967-5539
Date:
Jun 28, 2021
Telephone
Number:
503-799-2937
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
ITEMS 10 THROUGH 21
FILE NUMBER:
530-838
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?
No
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?
No
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?
$150,000
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?
03/2022
20. How many members did the labor organization
have at the end of the reporting period?
0
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
0
per
0
0
0
(b) Working Dues/Fees
0
per
0
0
0
(c) Initiation Fees
0
per
0
0
0
(d) Transfer Fees
0
per
0
0
0
(e) Work Permits
0
per
0
0
0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
STATEMENT A - ASSETS
AND LIABILITIES
FILE NUMBER:
530-838
ASSETS
ASSETS
Schedule
Number
Start of Reporting Period
(A)
End of Reporting Period
(B)
22. Cash
$653,079
$700,943
23. Accounts Receivable
1
$23,530
$1,318
24. Loans Receivable
2
$0
$0
25. U.S. Treasury
Securities
$0
$0
26. Investments
5
$0
$0
27. Fixed Assets
6
$17,684
$13,261
28. Other Assets
7
$1,894
$250
29.
TOTAL ASSETS
$696,187
$715,772
LIABILITIES
LIABILITIES
Schedule
Number
Start of Reporting Period
(A)
End of Reporting Period
(B)
30. Accounts Payable
8
$37,832
$36,975
31. Loans Payable
9
$100,000
$100,000
32. Mortgages Payable
$0
$0
33. Other Liabilities
10
$0
$0
34. TOTAL
LIABILITIES
$137,832
$136,975
35. NET
ASSETS
$558,355
$578,797
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
STATEMENT B -
RECEIPTS AND DISBURSEMENTS
FILE NUMBER:
530-838
CASH
RECEIPTS
SCH
AMOUNT
36. Dues and Agency Fees
$0
37. Per Capita Tax
$260,701
38. Fees, Fines,
Assessments, Work Permits
$0
39. Sale of Supplies
$0
40. Interest
$65
41. Dividends
$0
42. Rents
$0
43. Sale of Investments
and Fixed Assets
3
$0
44. Loans Obtained
9
$0
45. Repayments of Loans
Made
2
$0
46. On Behalf of
Affiliates for Transmittal to Them
$0
47. From Members for
Disbursement on Their Behalf
$0
48. Other Receipts
14
$132,060
49. TOTAL RECEIPTS
$392,826
CASH DISBURSEMENTS
SCH
AMOUNT
50.
Representational Activities
15
$152,426
51.
Political Activities and Lobbying
16
$38,673
52.
Contributions, Gifts, and Grants
17
$0
53. General
Overhead
18
$5,093
54. Union
Administration
19
$44,042
55. Benefits
20
$82,466
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 Assets
4
$2,149
61. Loans
Made
2
$0
62.
Repayment of Loans Obtained
9
$0
63. To
Affiliates of Funds Collected on Their Behalf
$0
64. On
Behalf of Individual Members
$0
65. Direct
Taxes
$0
66. Subtotal
$324,849
67.
Withholding Taxes and Payroll Deductions
67a. Total
Withheld
$64,913
67b. Less Total
Disbursed
$85,026
67c.
Total Withheld But Not Disbursed
-$20,113
68.
TOTAL DISBURSEMENTS
$344,962
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 1 - ACCOUNTS
RECEIVABLE AGING SCHEDULE
FILE NUMBER:
530-838
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
$1,318
Totals
(Total of Column (B) will be automatically entered in Item
23, Column(B))
$1,318
$0
$0
$0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 2 - LOANS
RECEIVABLE
FILE NUMBER:
530-838
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:
530-838
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:
530-838
Description (if land or buildings, give location)
(A)
Cost
(B)
Book Value
(C)
Cash Paid
(D)
Total
of all lines above
$2,149
$2,149
$2,149
Laptop computer
$2,149
$2,149
$2,149
Less Reinvestments
$0
(The
total from Net Purchases Line will be automatically
entered in Item 60.)
Net Purchases
$2,149
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 5 -
INVESTMENTS
FILE NUMBER:
530-838
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:
530-838
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
$73,317
$60,056
$13,261
$13,300
E.
Other Fixed Assets
F. Totals of Lines A through E
(Column(D) Total will be automatically entered in Item
27, Column(B))
$73,317
$60,056
$13,261
$13,300
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 7 - OTHER
ASSETS
FILE NUMBER:
530-838
Description
(A)
Book Value
(B)
Total
(Total will be automatically entered in Item 28, Column(B))
$250
Deposits and prepaid expenses
$250
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 8 - ACCOUNTS
PAYABLE AGING SCHEDULE
FILE NUMBER:
530-838
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
$36,975
$0
$0
$0
Totals
(Total for Column(B) will be automatically entered in Item
30, Column(D))
$36,975
$0
$0
$0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 9 - LOANS
PAYABLE
FILE NUMBER:
530-838
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
$100,000
$0
$0
$0
$100,000
Totals will be automatically entered in...
Item 31
Column (C)
Item 44
Item 62
Item 69
with Explanation
Item 31
Column (D)
ohwbst
$100,000
$0
$0
$0
$100,000
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 10 - OTHER
LIABILITIES
FILE NUMBER:
530-838
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:
530-838
(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
POWERS
,
MIKE
PRESIDENT N
$0
$0
$0
$0
$0
I
Schedule 15
Representational Activities
25
%
Schedule 16
Political Activities and Lobbying
50
%
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
25
%
A
B
C
NIEMI
,
MEG
VICE PRESIDENT C
$0
$0
$0
$0
$0
I
Schedule 15
Representational Activities
25
%
Schedule 16
Political Activities and Lobbying
50
%
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
25
%
A
B
C
UNGER
,
MELISSA
SECRETARY/TREASURER C
$0
$0
$0
$0
$0
I
Schedule 15
Representational Activities
25
%
Schedule 16
Political Activities and Lobbying
50
%
Schedule 17
Contributions
Schedule 18
General Overhead
Schedule 19
Administration
25
%
Total Officer
Disbursements
$0
$0
$0
$0
$0
Less Deductions
Net
Disbursements
$0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 12 -
DISBURSEMENTS TO EMPLOYEES
FILE NUMBER:
530-838
(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
BAKER
,
JENNIFER
DIRECTOR N/A
$70,191
$2,932
$653
$0
$73,776
I
Schedule 15
Representational Activities
80
%
Schedule 16
Political Activities and Lobbying
0
%
Schedule 17
Contributions
0
%
Schedule 18
General Overhead
0
%
Schedule 19
Administration
20
%
A
B
C
GALLEGOS
,
ALBERTO
POLITICAL ORGANIZER N/A
$73,444
$5,100
$827
$0
$79,371
I
Schedule 15
Representational Activities
50
%
Schedule 16
Political Activities and Lobbying
40
%
Schedule 17
Contributions
0
%
Schedule 18
General Overhead
0
%
Schedule 19
Administration
10
%
A
B
C
SCHOEPP
,
DELORES
FINANCE COORDINATOR N/A
$19,849
$0
$978
$0
$20,827
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
SHRIVER
,
KATHLEEN
LEGISLATIVE DIRECTOR N/A
$27,201
$0
$0
$0
$27,201
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
%
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
$190,685
$8,032
$2,458
$0
$201,175
Less
Deductions
Net Disbursements
$201,175
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 13 -
MEMBERSHIP STATUS
FILE NUMBER:
530-838
Category of Membership
(A)
Number
(B)
Voting Eligibility
(C)
Members
(Total of all lines above)
0
Agency Fee Payers*
Total Members/Fee Payers
0
*Agency Fee Payers are
not considered members of the labor organization.
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
DETAILED SUMMARY PAGE
- SCHEDULES 14 THROUGH 19
FILE NUMBER:
530-838
SCHEDULE 14 OTHER RECEIPTS
1. Named Payer
Itemized Receipts
$132,060
2. Named Payer
Non-itemized Receipts
$0
3. All Other Receipts
4. Total
Receipts
$132,060
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
6. Total
Disbursements
$0
SCHEDULE 15 REPRESENTATIONAL
ACTIVITIES
1. Named Payee
Itemized Disbursements
$11,096
2. Named Payee
Non-itemized Disbursements
$15,422
3. To Officers
$0
4. To Employees
$125,908
5. All Other
Disbursements
6. Total
Disbursements
$152,426
SCHEDULE 18 GENERAL OVERHEAD
1. Named Payee
Itemized Disbursements
$5,000
2. Named Payee
Non-itemized Disbursements
$0
3. To Officers
$0
4. To Employees
$0
5. All Other
Disbursements
$93
6. Total
Disbursements
$5,093
SCHEDULE 16 POLITICAL
ACTIVITIES AND LOBBYING
1. Named Payee
Itemized Disbursements
$6,925
2. Named Payee
Non-itemized Disbursements
$0
3. To Officers
$0
4. To Employees
$31,748
5. All Other
Disbursements
6. Total
Disbursements
$38,673
SCHEDULE 19 UNION
ADMINISTRATION
1. Named Payee
Itemized Disbursements
$0
2. Named Payee
Non-itemized Disbursements
$0
3. To Officers
$0
4. To Employees
$43,519
5. All Other
Disbursements
$523
6. Total
Disbursements
$44,042
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 14 - OTHER
RECEIPTS
FILE NUMBER:
530-838
Name and Address
(A)
OREGON HOMECARE WORKERS TRUST TRUST
1730 COMMERCIAL ST. SALEM OR 97302
Type or Classification
(B)
TRUST
Purpose
(C)
Date
(D)
Amount
(E)
Total
Itemized Transactions with this Payee/Payer
$57,060
Total
Non-Itemized Transactions with this Payee/Payer
Total of All Transactions with this
Payee/Payer for This Schedule
$57,060
ACA PROJECT REIMBURSEMENT
04/30/2020
$15,387
ACA PROJECT REIMBURSEMENT
05/29/2020
$3,747
ACA PROJECT REIMBURSEMENT
07/13/2020
$1,828
ACA PROJECT REIMBURSEMENT
08/04/2020
$6,106
ACA PROJECT REIMBURSEMENT
09/11/2020
$3,531
ACA PROJECT REIMBURSEMENT
10/22/2020
$7,986
ACA PROJECT REIMBURSEMENT
10/31/2020
$1,905
ACA PROJECT REIMBURSEMENT
11/23/2020
$3,034
ACA PROJECT REIMBURSEMENT
12/11/2020
$514
ACA PROJECT REIMBURSEMENT
12/22/2020
$2,195
ACA PROJECT REIMBURSEMENT
12/31/2020
$5,527
ACA PROJECT REIMBURSEMENT
01/22/2021
$1,835
ACA PROJECT REIMBURSEMENT
03/02/2021
$3,465
Name and Address
(A)
SEIU INTERNATIONAL UNION UNION
1800 MASSACHUSETTS AVE WASHINGTON DC 20038
Type or Classification
(B)
UNION
Purpose
(C)
Date
(D)
Amount
(E)
Total
Itemized Transactions with this Payee/Payer
$75,000
Total
Non-Itemized Transactions with this Payee/Payer
Total of All Transactions with this
Payee/Payer for This Schedule
$75,000
INFRASTRUCTURE SUBIDY
04/10/2020
$8,333
INFRASTRUCTURE SUBSIDY
05/05/2020
$8,333
INFRASTRUCTURE SUBSIDY
06/05/2020
$8,334
INFRASTRUCTURE SUBSIDY
07/02/2020
$8,333
INFRASTRUCTURE SUBSIDY
08/07/2020
$8,333
INFRASTRUCTURE SUBSIDY
09/04/2020
$8,334
INFRASTRUCTURE SUBSIDY
10/13/2020
$8,333
INFRASTRUCTURE SUBSIDY
11/06/2020
$8,333
INFRASTRUCTURE SUBSIDY
12/04/2020
$8,334
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 15 -
REPRESENTATIONAL ACTIVITIES
FILE NUMBER:
530-838
Name and Address
(A)
LEWIS BRISBOIS BISGAARD & SMITH LLP
633 W 5TH STREET, SUITE 400 LOS ANGELES CA 90071-2074
Type or Classification
(B)
PROFESSIONAL SERVICES
Purpose
(C)
Date
(D)
Amount
(E)
Total
Itemized Transactions with this Payee/Payer
Total
Non-Itemized Transactions with this Payee/Payer
$10,018
Total of All Transactions with this
Payee/Payer for This Schedule
$10,018
Name and Address
(A)
SERVICE MASTER BUILDING SERVICES 1213
CLACKAMAS OR 97015
Type or Classification
(B)
BUILDING SERVICES
Purpose
(C)
Date
(D)
Amount
(E)
Total
Itemized Transactions with this Payee/Payer
Total
Non-Itemized Transactions with this Payee/Payer
$5,380
Total of All Transactions with this
Payee/Payer for This Schedule
$5,380
Name and Address
(A)
UNION INSURANCE GROUP
303 W EIRE ST, #310 CHICAGO IL 60654
Type or Classification
(B)
INSURANCE
Purpose
(C)
Date
(D)
Amount
(E)
Total
Itemized Transactions with this Payee/Payer
$11,096
Total
Non-Itemized Transactions with this Payee/Payer
$24
Total of All Transactions with this
Payee/Payer for This Schedule
$11,120
INSURANCE
07/02/2020
$11,096
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 16 -
POLITICAL ACTIVITIES AND LOBBYING
FILE NUMBER
530-838
Name and Address
(A)
BALLOT READY
332 SW MICHIGAN AVE CHICAGO IL 60604
Type or Classification
(B)
POLITICAL/LOBBYING
Purpose
(C)
Date
(D)
Amount
(E)
Total
Itemized Transactions with this Payee/Payer
$6,925
Total
Non-Itemized Transactions with this Payee/Payer
Total of All Transactions with this
Payee/Payer for This Schedule
$6,925
VOTER GUIDE
04/29/2020
$6,925
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 17 -
CONTRIBUTIONS, GIFTS & GRANTS
FILE NUMBER:
530-838
There was no data
found for this schedule.
SCHEDULE 18 - GENERAL
OVERHEAD
FILE NUMBER:
530-838
Name and Address
(A)
OUR OREGON
618 NW GLISAN PORTLAND OR 97209
Type or Classification
(B)
DATA MANAGEMENT
Purpose
(C)
Date
(D)
Amount
(E)
Total
Itemized Transactions with this Payee/Payer
$5,000
Total
Non-Itemized Transactions with this Payee/Payer
Total of All Transactions with this
Payee/Payer for This Schedule
$5,000
DATA MANAGEMENT
10/20/2020
$5,000
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 19 - UNION
ADMINISTRATION
FILE NUMBER:
530-838
There was no data
found for this schedule.
SCHEDULE 20 -
BENEFITS
FILE NUMBER:
530-838
Description
(A)
To Whom Paid
(B)
Amount
(C)
Total of all
lines above (Total will be automatically entered in Item
55.)