U.S Department of Labor
Office of Labor-Management Standards
Washington, DC 20210
LM-10
EMPLOYER REPORT
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.
Form Approved
Office of Management and Budget
OMB No. 1245-0003 .
Expires 01-31-2025 .
 For Official Use Only


 E
READ THE INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS REPORT.
PART A
 1. File Number: E-69495
 2. Fiscal Year CoveredFrom:01/01/2021Through:12/31/2021
                                                    Month/Day/Year               Month/Day/Year
3. Name and address of Reporting Employer (inc. trade name, if any).
Employer:Colectivo Coffee Roasters, Inc.
Trade Name:
Attention To:Paul  Miller
Title:Vice President
Mailing Address
P.O. Box., Bldg., Room No., if any:
Street:2999 N Humboldt Blvd
City:MilwaukeeState:WI
ZIP Code + 4:53212
4. Name and address of President or corresponding principal officer, if different from address in Item 3.
Name:
P.O. Box., Bldg., Room No., if any:
Street:
City:State:
ZIP Code + 4:
5.
Any other address where records necessary to verify this report will be available for examination.
Name:
Title:
Organization:
P.O. Box., Bldg., Room No., if any:
Street:
City:State:
ZIP Code + 4:
6.
Indicate by checking the appropriate box or boxes where records necessary to verify this report will be available for examination.

X Address in Item 3
 Address in Item 4
 Address in Item 5
  7. Type of organization.
  X Corporation       Partnership       Individual       Other (specify)
Signatures
Each of the undersigned, duly authorized officers of the above employer declares, under penalty of perjury and other applicable penalties of law, that all of the information submitted in this report (including the information contained in any accompanying documents) has been examined by the signatory and is, to the best of the undersigned's knowledge and belief, true, correct, and complete. (See Section VIII on penalties in the instructions.)
13.
SIGNED: Paul Miller
Title: VICE PRESIDENT
On Date: Mar 09, 2022
Telephone Number: 414-750-5344
14.
SIGNED: Paul Miller
Title: TREASURER
On Date: Mar 09, 2022
Telephone Number: 414-750-5344
Form LM-10 (2003)
8.
Type of Reportable Activity Engaged In By Employer

Read the following questions and the accompanying instructions carefully, taking into consideration the exclusions listed in the instructions for these items, and check either ''Yes" or ''No'' for each item. For each item that is answered ''Yes'', you must attach a Part B which appears on Page 3. Complete a separate Part B for each ''Yes'' answer to any of Items 8.a. through 8.f. Also, if the answer is ''Yes'' for more than one person or organization, complete a separate Part B for each person or organization. If you answer ''Yes'', enter the number of Part Bs that are submitted for that item in the line indicated.
DURING THE FISCAL YEAR COVERED BY THIS REPORT:
    If "Yes",     number of     Part Bs     attached

8.a
Did you make or promise or agree to make, directly or indirectly, any payment or loan of money or other thing of value (including reimbursed expenses) to any labor organization or to any officer, agent, shop steward, or other representative or employee of any labor organization?
 YES   NOX
0

8.b
Did you make, directly or indirectly, any payment (including reimbursed expenses) to any of your employees, or to any group or committee of your employees, for the purpose of causing them to persuade other employees to exercise or not to exercise, or as to the manner of exercising, the right to organize and bargain collectively through representatives of their own choosing without previously or at the same time disclosing such payment to all such other employees?
  YES   NOX
0

8.c
Did you make any expenditure where an object thereof, directly or indirectly, was to interfere with, restrain, or coerce employees in the right to organize and bargain collectively through representatives of their own choosing?
  YES  NOX
0

8.d
Did you make any expenditure where an object thereof, directly or indirectly, was to obtain information concerning the activities of employees or of a labor organization in connection with a labor dispute in which you were involved?
  YES  NOX
0

8.e
Did you make any agreement or arrangement with a labor relations consultant or other independent contractor or organization pursuant to which such person undertook activities where an object thereof, directly or indirectly, was to persuade employees to exercise or not to exercise, or as to the manner of exercising, the right to organize and bargain collectively through representatives of their own choosing; or did you make any payment (including reimbursed expenses) pursuant to such an agreement or arrangement?
 YESX  NO
1

8.f
Did you make any agreement or arrangement with a labor relations consultant or other independent contractor or organization pursuant to which such person undertook activities where an object thereof, directly or indirectly, was to furnish you with information concerning activities of employees or of a labor organization in connection with a labor dispute in which you were involved; or did you make any payment pursuant to such agreement or arrangement?
  YES  NOX
0


TOTAL NUMBER OF PART Bs FOR THIS REPORT IS:1

Form LM-10 (2003)
Check Item Number(from Page 2) to which this Part B applies
ITEM 8.a.
ITEM 8.b.
ITEM 8.c.
ITEM 8.d.
ITEM 8.e. X
ITEM 8.f.

 9.a. Agreement       X Payment       Both
 9.c. Position In labor organization or with employer (if an independent labor consultant, so state).President
9.b. Name and address of person with whom or through whom a separate agreement was made or to whom payments were made.
Name:Phil Wilson
P.O. Box., Bldg., Room No., if any:
Street:7850 S. Elm Place
City:Broken ArrowState:OK
ZIP Code + 4:74011
9.d. Name and address of firm or labor organization with whom employed or affiliated.
Organization: LRI Consulting Services Inc.
P.O. Box., Bldg., Room No., if any:
Street:7850 S. Elm Place
City:Broken ArrowState:OK
ZIP Code + 4:74011
10.a.
    Date of the promise, agreement, or arrangement pursuant to which payments or expenditures were agreed to or made.
09/24/2020
10.b.
    The promise, agreement, or arrangement was:

Oral       X Written*       Both

(*Written agreements entered into during the fiscal year must be attached.)
11.a. Date of each payment or expenditure (mm/dd/yyyy). 11.b. Amount of each payment or expenditure 11.c. Kind of each payment or expenditure (Specify whether payment or loan, and whether in cash or property)
02/25/2021
  $35,479
  check payment
03/02/2021
  $16,461
  check payment
03/15/2021
  $35,911
  check payment
03/22/2021
  $7,717
  check payment
12.
Explain fully the circumstances of all payments, including the terms of any oral agreement or understanding pursuant to which they were made : Engaged to communicate to employees regarding exercising their rights to organize and bargain collectively. $375/hour/consultant plus reasonable travel expenses.
Form LM-10 (2003)