040-094 (LM2) 06/30/2022

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: 01-31-2025

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
040-094

2. PERIOD COVERED
From	07/01/2021
Through	06/30/2022

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 TEACHERS AFL-CIO
5. DESIGNATION (Local, Lodge, etc.) STATE ASSOCIATION	6. DESIGNATION NBR
7. UNIT NAME (if any) OHIO NURSES ASSOCIATION -- OH 5903

8. MAILING ADDRESS (Type or print in capital letters)
First Name LISA	Last Name OCHS
P.O Box - Building and Room Number
Number and Street 3760 RIDGE MILL DR.
City HILLIARD
State OH	ZIP Code + 4 43026

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:

Robert B Weitzel

PRESIDENT

71. SIGNED:

Janet R Corbin

TREASURER

Date:

Sep 29, 2022

Telephone Number:

513-324-0988

Date:

Sep 29, 2022

Telephone Number:

614-206-0269

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

ITEMS 10 THROUGH 21

FILE NUMBER: 040-094

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?	10/2023

20. How many members did the labor organization have at the end of the reporting period?

8,425

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	Range	per	Year	510.71	766.55
(b) Working Dues/Fees		per
(c) Initiation Fees		per
(d) Transfer Fees		per
(e) Work Permits		per

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

STATEMENT A - ASSETS AND LIABILITIES

FILE NUMBER: 040-094

ASSETS

ASSETS	Schedule Number	Start of Reporting Period (A)	End of Reporting Period (B)
22. Cash		$1,299,696	$1,008,773
23. Accounts Receivable	1	$15,216	$124,723
24. Loans Receivable	2	$0	$0
25. U.S. Treasury Securities		$0	$0
26. Investments	5	$1,727,875	$1,538,968
27. Fixed Assets	6	$1,325,659	$981,360
28. Other Assets	7	$38,040	$17,032
29. TOTAL ASSETS		$4,406,486	$3,670,856

LIABILITIES

LIABILITIES	Schedule Number	Start of Reporting Period (A)	End of Reporting Period (B)
30. Accounts Payable	8	$278,205	$0
31. Loans Payable	9	$0	$0
32. Mortgages Payable		$0	$0
33. Other Liabilities	10	$601,901	$519,648
34. TOTAL LIABILITIES		$880,106	$519,648

35. NET ASSETS

$3,526,380

$3,151,208

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

STATEMENT B - RECEIPTS AND DISBURSEMENTS

FILE NUMBER: 040-094

CASH RECEIPTS	SCH	AMOUNT
36. Dues and Agency Fees		$3,574,129
37. Per Capita Tax		$0
38. Fees, Fines, Assessments, Work Permits		$0
39. Sale of Supplies		$0
40. Interest		$74
41. Dividends		$168,520
42. Rents		$0
43. Sale of Investments and Fixed Assets	3	$1,103,791
44. Loans Obtained	9	$0
45. Repayments of Loans Made	2	$0
46. On Behalf of Affiliates for Transmittal to Them		$2,572,481
47. From Members for Disbursement on Their Behalf		$0
48. Other Receipts	14	$478,597
49. TOTAL RECEIPTS		$7,897,592

CASH DISBURSEMENTS		SCH	AMOUNT
50. Representational Activities		15	$1,196,780
51. Political Activities and Lobbying		16	$226,008
52. Contributions, Gifts, and Grants		17	$7,000
53. General Overhead		18	$1,956,291
54. Union Administration		19	$182,210
55. Benefits		20	$1,114,585
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	$865,469
61. Loans Made		2	$0
62. Repayment of Loans Obtained		9	$0
63. To Affiliates of Funds Collected on Their Behalf			$2,446,660
64. On Behalf of Individual Members			$0
65. Direct Taxes			$200,828

66. Subtotal			$8,195,831
67. Withholding Taxes and Payroll Deductions
67a. Total Withheld	$760,688
67b. Less Total Disbursed	$760,688
67c. Total Withheld But Not Disbursed
68. TOTAL DISBURSEMENTS			$8,195,831

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 1 - ACCOUNTS RECEIVABLE AGING SCHEDULE

FILE NUMBER: 040-094

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	$124,723		$250
Totals (Total of Column (B) will be automatically entered in Item 23, Column(B))	$124,723	$0	$250	$0

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 2 - LOANS RECEIVABLE

FILE NUMBER: 040-094

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

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: 040-094

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	$1,109,277	$1,014,509	$1,103,791	$1,103,791
Building, 3760 Ridge Mill Dr. Hilliard, OH 43026	$1,109,277	$1,014,509	$1,103,791	$1,103,791

				Less Reinvestments	$0
(The total from Net Sales Line will be automatically entered in Item 43)				Net Sales	$1,103,791

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 4 - PURCHASE OF INVESTMENTS AND FIXED ASSETS

FILE NUMBER: 040-094

Description (if land or buildings, give location) (A)	Cost (B)	Book Value (C)	Cash Paid (D)
Total of all lines above	$865,469	$865,469	$865,469
Deposit for new building	$758,531	$758,531	$758,531
Computer Software	$106,938	$106,938	$106,938

		Less Reinvestments	$0
(The total from Net Purchases Line will be automatically entered in Item 60.)		Net Purchases	$865,469

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 5 - INVESTMENTS

FILE NUMBER: 040-094

Description (A)	Amount (B)
Marketable Securities
A. Total Cost	$1,715,143
B. Total Book Value	$1,538,968
C. List each marketable security which has a book value over $5,000 and exceeds 5% of Line B.

PIMCO Income Fund Class A	$506,227
PIMCO Fds Pac Invt Mgm Low Duration Fd Cl A	$171,194
PIMCO Fds PAC Invt Mgt Ser Stockplus Absolute Ret	$270,527
PIM Fds PAC Invt Mgt SER Stockplus Fund Class A	$99,969
PIMCO Fds PAC Invt Mgmt Ser Low Dur Inc Fd Cl A	$103,475
PIMCO Funds Rae Fund A	$119,725

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))

$1,538,968

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 6 - FIXED ASSETS

FILE NUMBER: 040-094

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)

C. Automobiles and Other Vehicles

D. Office Furniture and Equipment

$16,697

$12,874

$3,823

E. Other Fixed Assets

$1,364,590

$387,053

$977,537

F. Totals of Lines A through E (Column(D) Total will be automatically entered in Item 27, Column(B))

$1,381,287

$399,927

$981,360

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 7 - OTHER ASSETS

FILE NUMBER: 040-094

Description (A)	Book Value (B)
Total (Total will be automatically entered in Item 28, Column(B))	$17,032
Prepaid Expenses	$17,032

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 8 - ACCOUNTS PAYABLE AGING SCHEDULE

FILE NUMBER: 040-094

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: 040-094

Source of Loans Payable at Any Time During the Reporting Period (A)	Loans Owed at Start of Period (B)	Loans Obtained During Period (C)	Repayment During Period Cash (D)(1)	Repayment During Period Other Than Cash (D)(2)	Loans Owed at End of Period (E)
Total Loans Payable	$0	$0	$0	$0	$0
Totals will be automatically entered in...	Item 31 Column (C)	Item 44	Item 62	Item 69 with Explanation	Item 31 Column (D)

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 10 - OTHER LIABILITIES

FILE NUMBER: 040-094

Description (A)	Amount at End of Period (B)
Total Other Liabilities (Total will be automatically entered in Item 33, Column(D))	$519,648
Accrued Payroll Expenses	$195,139
Payables to Affiliates	$188,938
Lease Obligations	$13,334
Other Liabilities	$122,237

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 11 - ALL OFFICERS AND DISBURSEMENTS TO OFFICERS

FILE NUMBER: 040-094

(A)
Name

(B)
Title

(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

Weitzel , Robert
President
C

$3,200

$992

$4,192

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

Schedule 19
Administration

100 %

A
B
C

Arms , Deborah
Past President
P

$1,600

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

Schedule 19
Administration

100 %

A
B
C

Lucas , Rick
1st vice President
C

$275

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

Schedule 19
Administration

100 %

A
B
C

Tucker , Jacinta
2nd Vice President
C

$129

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

Schedule 19
Administration

100 %

A
B
C

Thoman , Michelle
Secretary
C

$610

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

Schedule 19
Administration

100 %

A
B
C

Corbin , Janet
Treasurer
C

$25

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

Schedule 19
Administration

100 %

A
B
C

Baker-Loyd , Deborah
Director
C

$36

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

Schedule 19
Administration

100 %

A
B
C

McGhee , Barbara
Director
C

$585

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

Schedule 19
Administration

100 %

A
B
C

Henderson , Catherine
Director
C

$36

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

Schedule 19
Administration

100 %

A
B
C

Burchett , Jamie
Director
C

$435

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

Schedule 19
Administration

100 %

A
B
C

Garrett , Benitha
Director
C

$250

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

Schedule 19
Administration

100 %

A
B
C

Ingledue , Tammi
Director
C

$70

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

Schedule 19
Administration

100 %

A
B
C

Powell , Joyce
Director
P

$358

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

Schedule 19
Administration

100 %

A
B
C

Roe , Carol
Director
P

$86

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

Schedule 19
Administration

100 %

A
B
C

Marcentile , Iris
Director
P

$224

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

Schedule 19
Administration

100 %

Total Officer Disbursements	$0	$4,800	$4,111	$0	$8,911
Less Deductions
Net Disbursements					$8,911

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 12 - DISBURSEMENTS TO EMPLOYEES

FILE NUMBER: 040-094

(A)
Name

(B)
Title

(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

Bailey , Kristen
Labor Representative
None

$85,286

$6,169

$91,455

Schedule 15
Representational Activities

92 %

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

4 %

Schedule 19
Administration

4 %

A
B
C

Bloomer , Phillip
Organizer
None

$53,739

$4,701

$58,440

Schedule 15
Representational Activities

100 %

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

Schedule 19
Administration

A
B
C

Bukoffsky , Tiffany
Director of Health Policy
None

$112,631

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

94 %

Schedule 17
Contributions

Schedule 18
General Overhead

6 %

Schedule 19
Administration

A
B
C

Carmack , Carolyn
Labor Representative
None

$55,448

$1,420

$56,868

Schedule 15
Representational Activities

85 %

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

15 %

Schedule 19
Administration

A
B
C

Cousins , Bob
DEO Labor Representative
None

$155,961

$3,403

$159,364

Schedule 15
Representational Activities

68 %

Schedule 16
Political Activities and Lobbying

1 %

Schedule 17
Contributions

Schedule 18
General Overhead

29 %

Schedule 19
Administration

2 %

A
B
C

Donovan , Michelle
Comm and Development
None

$52,998

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

100 %

Schedule 19
Administration

A
B
C

Dowden , Dodie
Membership Engagement
None

$81,201

$653

$81,854

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

100 %

Schedule 19
Administration

A
B
C

Dugan , Dennis
Labor Representative
None

$84,046

$831

$84,877

Schedule 15
Representational Activities

100 %

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

Schedule 19
Administration

A
B
C

Gehrisch , Alex
Membership Controller
None

$52,711

$200

$52,911

Schedule 15
Representational Activities

100 %

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

Schedule 19
Administration

A
B
C

Dzubak , Jessica
Dir. of Nurse Practice
None

$36,651

$269

$36,920

Schedule 15
Representational Activities

96 %

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

4 %

Schedule 19
Administration

A
B
C

Gleba , Thomas
Labor Representative
None

$21,476

$2,382

$23,858

Schedule 15
Representational Activities

96 %

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

4 %

Schedule 19
Administration

A
B
C

Homan , Molly
Dir of Marketing & Tech
None

$97,033

$277

$97,310

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

100 %

Schedule 19
Administration

A
B
C

Humphreys , James
Organizer
None

$67,173

$824

$67,997

Schedule 15
Representational Activities

96 %

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

1 %

Schedule 19
Administration

3 %

A
B
C

Koparde , Sangita
Organizer
None

$67,946

$362

$68,308

Schedule 15
Representational Activities

96 %

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

4 %

Schedule 19
Administration

A
B
C

Lemery , Angela
Business Office Admin
None

$84,274

$598

$84,872

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

100 %

Schedule 19
Administration

A
B
C

Marlow , Brandon
Labor Representative
None

$86,923

$6,097

$93,020

Schedule 15
Representational Activities

100 %

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

Schedule 19
Administration

A
B
C

McClelland , Cathy
Finance Manager
None

$76,028

$646

$76,674

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

100 %

Schedule 19
Administration

A
B
C

Mendiola , Dominic
Labor Representative
None

$87,437

$5,232

$92,669

Schedule 15
Representational Activities

98 %

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

2 %

Schedule 19
Administration

A
B
C

Mueller , Anne
Labor Representative
None

$90,500

$7,554

$98,054

Schedule 15
Representational Activities

91 %

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

5 %

Schedule 19
Administration

4 %

A
B
C

Ochs , Lisa
CEO
None

$165,883

$4,093

$169,976

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

100 %

Schedule 19
Administration

A
B
C

Ransone , Anne
DEO Operations
None

$133,572

$151

$133,723

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

100 %

Schedule 19
Administration

A
B
C

Schweitzer , Kelli
Sr. Director of Pro Pract
None

$114,979

$393

$115,372

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

100 %

Schedule 19
Administration

A
B
C

Smith , Robin
Membership Controller
None

$82,530

$317

$82,847

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

1 %

Schedule 19
Administration

99 %

A
B
C

Swearingen , Sandy
CE Specialist
None

$67,174

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

100 %

Schedule 19
Administration

A
B
C

Turner , Brittany
Nurse Planner
None

$73,834

$147

$73,981

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

1 %

Schedule 17
Contributions

Schedule 18
General Overhead

99 %

Schedule 19
Administration

A
B
C

Walker , Lisa
Health Policy Specialist
None

$70,401

Schedule 15
Representational Activities

3 %

Schedule 16
Political Activities and Lobbying

75 %

Schedule 17
Contributions

Schedule 18
General Overhead

22 %

Schedule 19
Administration

A
B
C

Whitehurst , Jacob
Cust Ser Admin & Mem Supp
None

$43,242

Schedule 15
Representational Activities

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

100 %

Schedule 19
Administration

A
B
C

Wolfe , Rachel
Executive Assistant
None

$78,714

Schedule 15
Representational Activities

73 %

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

25 %

Schedule 19
Administration

2 %

TOTALS RECEIVED BY EMPLOYEES MAKING $10,000 OR LESS

$2,306

Schedule 15
Representational Activities

71 %

Schedule 16
Political Activities and Lobbying

Schedule 17
Contributions

Schedule 18
General Overhead

29 %

Schedule 19
Administration

Total Employee Disbursements	$2,282,097	$0	$46,719	$0	$2,328,816
Less Deductions
Net Disbursements					$2,328,816

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 13 - MEMBERSHIP STATUS

FILE NUMBER: 040-094

Category of Membership (A)	Number (B)	Voting Eligibility (C)
Members (Total of all lines above)	8,425
Agency Fee Payers*
Total Members/Fee Payers	8,425
*Agency Fee Payers are not considered members of the labor organization.
Members Full Rate 100%	7,380	Yes
Members Full Rate 50%	750	Yes
Members Full Rate 25%	295	Yes

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

DETAILED SUMMARY PAGE - SCHEDULES 14 THROUGH 19

FILE NUMBER: 040-094

SCHEDULE 14 OTHER RECEIPTS
1. Named Payer Itemized Receipts	$6,500
2. Named Payer Non-itemized Receipts	$0
3. All Other Receipts	$472,097
4. Total Receipts	$478,597

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	$7,000
6. Total Disbursements	$7,000

SCHEDULE 15 REPRESENTATIONAL ACTIVITIES
1. Named Payee Itemized Disbursements	$68,771
2. Named Payee Non-itemized Disbursements	$151,749
3. To Officers	$0
4. To Employees	$960,548
5. All Other Disbursements	$15,712
6. Total Disbursements	$1,196,780

SCHEDULE 18 GENERAL OVERHEAD
1. Named Payee Itemized Disbursements	$338,209
2. Named Payee Non-itemized Disbursements	$305,728
3. To Officers	$0
4. To Employees	$1,110,861
5. All Other Disbursements	$201,493
6. Total Disbursements	$1,956,291

SCHEDULE 16 POLITICAL ACTIVITIES AND LOBBYING
1. Named Payee Itemized Disbursements	$0
2. Named Payee Non-itemized Disbursements	$65,000
3. To Officers	$0
4. To Employees	$161,008
5. All Other Disbursements	$0
6. Total Disbursements	$226,008

SCHEDULE 19 UNION ADMINISTRATION
1. Named Payee Itemized Disbursements	$25,885
2. Named Payee Non-itemized Disbursements	$2,080
3. To Officers	$8,911
4. To Employees	$96,400
5. All Other Disbursements	$48,934
6. Total Disbursements	$182,210

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 14 - OTHER RECEIPTS

FILE NUMBER: 040-094

Name and Address
(A)

California Casualty Management

1900 Almeda de las Pulga
San Mateo
CA
94403

Type or Classification
(B)

Royalties

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$6,500
Total Non-Itemized Transactions with this Payee/Payer
Total of All Transactions with this Payee/Payer for This Schedule		$6,500
Royalties	10/18/2021	$6,500

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 15 - REPRESENTATIONAL ACTIVITIES

FILE NUMBER: 040-094

Name and Address
(A)

Barkan Meizlish, LP

250 East Broad Street
Columbus
OH
43215

Type or Classification
(B)

Attorney

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$36,218
Total Non-Itemized Transactions with this Payee/Payer		$17,290
Total of All Transactions with this Payee/Payer for This Schedule		$53,508
Legal Services	08/02/2021	$5,147
Legal Services	08/11/2021	$11,898
Legal Services	09/20/2021	$11,777
Legal Services	12/16/2021	$7,396

Name and Address
(A)

Bloomberg Industry Group
PO Box 419889

Boston
MA
02241

Type or Classification
(B)

Publications

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer		$15,899
Total of All Transactions with this Payee/Payer for This Schedule		$15,899

Name and Address
(A)

Cloppert Latanick Sauter

225 East Broad Street
Columbus
OH
43215

Type or Classification
(B)

Attorney

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$26,920
Total Non-Itemized Transactions with this Payee/Payer		$96,773
Total of All Transactions with this Payee/Payer for This Schedule		$123,693
Legal Fees	04/11/2022	$12,400
Legal Fees	04/21/2022	$14,520

Name and Address
(A)

Election America

155 Mineola Blvd. Suite 102
Mineola
NY
11501

Type or Classification
(B)

Convention voting

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$5,633
Total Non-Itemized Transactions with this Payee/Payer		$1,878
Total of All Transactions with this Payee/Payer for This Schedule		$7,511
Convention	09/07/2021	$5,633

Name and Address
(A)

Holiday Inn

175 E. Town St
Columbus
OH
43215

Type or Classification
(B)

Lodging

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer		$14,904
Total of All Transactions with this Payee/Payer for This Schedule		$14,904

Name and Address
(A)

Hyatt Hotels Corporation

150 North Riverside Plaza
Chicago
IL
60606

Type or Classification
(B)

Lodging

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer		$5,005
Total of All Transactions with this Payee/Payer for This Schedule		$5,005

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 16 - POLITICAL ACTIVITIES AND LOBBYING

FILE NUMBER 040-094

Name and Address
(A)

Government Advantage Group

17 South High St. Suite 750
Columbus
OH
43215

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		$65,000
Total of All Transactions with this Payee/Payer for This Schedule		$65,000

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 17 - CONTRIBUTIONS, GIFTS & GRANTS

FILE NUMBER: 040-094

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: 040-094

Name and Address
(A)

AAA Ohio Auto Club

90 E. Wilson Bridge Rd.
Worthington
OH
43085

Type or Classification
(B)

Subscriptions

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer		$5,353
Total of All Transactions with this Payee/Payer for This Schedule		$5,353

Name and Address
(A)

Advance Ohio
P. O. Box 77000

Detroit
MI
48277

Type or Classification
(B)

Marketing

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
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)

Amazon
410 Terry Ave

Seattle
WA
98109

Type or Classification
(B)

Supplies

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer		$14,093
Total of All Transactions with this Payee/Payer for This Schedule		$14,093

Name and Address
(A)

American Electric Power
PO Box 371496

Pittsburgh
PA
15250

Type or Classification
(B)

Utility

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer		$8,028
Total of All Transactions with this Payee/Payer for This Schedule		$8,028

Name and Address
(A)

Arthur L. Davis Publishing Agency, Inc
PO Box 216

Cedar Falls
IA
50613

Type or Classification
(B)

Publication

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$31,544
Total Non-Itemized Transactions with this Payee/Payer		$7,000
Total of All Transactions with this Payee/Payer for This Schedule		$38,544
ONR Publication	09/28/2021	$10,544
ONR Publication	12/13/2021	$7,000
ONR Publication	04/11/2022	$7,000
ONR Publication	06/09/2022	$7,000

Name and Address
(A)

Authorize.net
P.O Box 947

American Fork
UT
84003

Type or Classification
(B)

Merchant Services

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer		$19,665
Total of All Transactions with this Payee/Payer for This Schedule		$19,665

Name and Address
(A)

Blue & Co. LLC
2712 Solution Center

Chicago
IL
60677

Type or Classification
(B)

Accounting Services

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$13,400
Total Non-Itemized Transactions with this Payee/Payer		$17,000
Total of All Transactions with this Payee/Payer for This Schedule		$30,400
Audit & Tax Services	09/24/2021	$6,250
Audit & Tax Services	01/26/2022	$7,150

Name and Address
(A)

Cincinnati Insurance
PO Box 145620

Cincinnati
OH
45250

Type or Classification
(B)

Insurance

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$27,243
Total Non-Itemized Transactions with this Payee/Payer		$767
Total of All Transactions with this Payee/Payer for This Schedule		$28,010
Insurance	11/18/2021	$16,393
Insurance	12/16/2021	$10,850

Name and Address
(A)

City of Dublin

5600 Post Rd
Dublin
OH
43017

Type or Classification
(B)

Summer Outing

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer		$8,000
Total of All Transactions with this Payee/Payer for This Schedule		$8,000

Name and Address
(A)

CommPartners

7230 Lee Deforest Dr St 270
Columbia
MD
21046

Type or Classification
(B)

Database Licenses

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$5,300
Total Non-Itemized Transactions with this Payee/Payer
Total of All Transactions with this Payee/Payer for This Schedule		$5,300
Database Licenses	08/05/2021	$5,300

Name and Address
(A)

Easy Permit Postage

3001 Summer St.
Stamford
CT
06926

Type or Classification
(B)

Postage Machine

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer		$5,683
Total of All Transactions with this Payee/Payer for This Schedule		$5,683

Name and Address
(A)

Extra Space
3929 Dublin Rd

Hilliard
OH
43026

Type or Classification
(B)

Storage Facilities

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer		$13,040
Total of All Transactions with this Payee/Payer for This Schedule		$13,040

Name and Address
(A)

Frantz Investments

300 Spruce St., Suite 110
Columbus
OH
43215

Type or Classification
(B)

Building Lease

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$13,317
Total Non-Itemized Transactions with this Payee/Payer
Total of All Transactions with this Payee/Payer for This Schedule		$13,317
Building Lease	12/13/2021	$13,317

Name and Address
(A)

GFC Leasing
2675 Research Park Drive

Madison
WI
53711

Type or Classification
(B)

Equipment Lease

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$7,321
Total Non-Itemized Transactions with this Payee/Payer		$8,900
Total of All Transactions with this Payee/Payer for This Schedule		$16,221
Equipment Lease	06/30/2022	$7,321

Name and Address
(A)

Higher Logic
PO Box 645579

Pittsburgh
PA
15264

Type or Classification
(B)

Communications

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$57,136
Total Non-Itemized Transactions with this Payee/Payer
Total of All Transactions with this Payee/Payer for This Schedule		$57,136
Software	07/19/2021	$44,626
Software	08/02/2021	$4,050
Software	09/07/2021	$8,460

Name and Address
(A)

Howell & Associates, CPA
501 W. Schrock Rd.

Westerville
OH
43081

Type or Classification
(B)

Consultant

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer		$30,000
Total of All Transactions with this Payee/Payer for This Schedule		$30,000

Name and Address
(A)

L&E Landscape
PO Box 1431

Westerville
OH
43081

Type or Classification
(B)

Landscaping

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer		$5,285
Total of All Transactions with this Payee/Payer for This Schedule		$5,285

Name and Address
(A)

Lamar Companies
P.O. Box 96030

Baton Rouge
LA
70896

Type or Classification
(B)

Advertising

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$13,700
Total Non-Itemized Transactions with this Payee/Payer		$2,905
Total of All Transactions with this Payee/Payer for This Schedule		$16,605
Advertising	07/20/2021	$5,600
Advertising	06/06/2022	$8,100

Name and Address
(A)

Lenovo Corporation

7001 Development Dr.
Morrisville
NC
27560

Type or Classification
(B)

IT Equipment

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$6,097
Total Non-Itemized Transactions with this Payee/Payer		$2,050
Total of All Transactions with this Payee/Payer for This Schedule		$8,147
IT Equipment	01/26/2022	$6,097

Name and Address
(A)

Main and Nelson Station, LLC

1855 E. Main St
Columbus
OH
43205

Type or Classification
(B)

Building Lease

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$15,220
Total Non-Itemized Transactions with this Payee/Payer
Total of All Transactions with this Payee/Payer for This Schedule		$15,220
Building Lease	05/20/2022	$15,220

Name and Address
(A)

Nationwide Hotel

100 Green Meadows Dr. S
Lewis Center
OH
43035

Type or Classification
(B)

Meeting Rooms

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$9,250
Total Non-Itemized Transactions with this Payee/Payer
Total of All Transactions with this Payee/Payer for This Schedule		$9,250
Board Meetings	01/21/2022	$9,250

Name and Address
(A)

NimbleUser
1100 Pittsford Victor Road

Pittsford
NY
14534

Type or Classification
(B)

Membership Database

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$45,890
Total Non-Itemized Transactions with this Payee/Payer
Total of All Transactions with this Payee/Payer for This Schedule		$45,890
Database	11/18/2021	$45,890

Name and Address
(A)

Patio Printing
5663 Huntley Rd

Columbus
OH
43229

Type or Classification
(B)

Printing

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$20,620
Total Non-Itemized Transactions with this Payee/Payer		$40,245
Total of All Transactions with this Payee/Payer for This Schedule		$60,865
Printing	05/03/2022	$5,880
Printing	04/28/2022	$8,650
Printing	01/14/2022	$6,090

Name and Address
(A)

Pitney Bowes Global Financial
PO Box 371887

Pittsburgh
PA
15250

Type or Classification
(B)

Postage Machine Lease

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer		$11,236
Total of All Transactions with this Payee/Payer for This Schedule		$11,236

Name and Address
(A)

Pro OnCall Technologies
6902 Kemper Road

Cincinnati
OH
45249

Type or Classification
(B)

IT Consultant

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer		$40,077
Total of All Transactions with this Payee/Payer for This Schedule		$40,077

Name and Address
(A)

Put-in-Bay Resort

439 Loraine Ave
Put in Bay
OH
43456

Type or Classification
(B)

Resort

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$11,637
Total Non-Itemized Transactions with this Payee/Payer		$2,772
Total of All Transactions with this Payee/Payer for This Schedule		$14,409
Staff Retreat	05/18/2022	$5,671
Staff Retreat	05/19/2022	$5,966

Name and Address
(A)

Robert Stein, NAA

1675 Main St. Suite 270
Kent
OH
44240

Type or Classification
(B)

Arbitration Services

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer		$5,650
Total of All Transactions with this Payee/Payer for This Schedule		$5,650

Name and Address
(A)

Slicktext
301 E. Second St. Suite 308

Jamestown
NY
14701

Type or Classification
(B)

Communications

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer		$11,044
Total of All Transactions with this Payee/Payer for This Schedule		$11,044

Name and Address
(A)

Staples

500 Staples Dr.
Framingham
MA
01702

Type or Classification
(B)

Supplies

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer		$5,348
Total of All Transactions with this Payee/Payer for This Schedule		$5,348

Name and Address
(A)

Time Warner Cable
PO Box 223085

Pittsburgh
PA
15251

Type or Classification
(B)

Internet Service Provider

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer		$10,606
Total of All Transactions with this Payee/Payer for This Schedule		$10,606

Name and Address
(A)

Verizon
PO Box 25505

Lehigh Valley
PA
18002

Type or Classification
(B)

Telecommunications

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer		$9,921
Total of All Transactions with this Payee/Payer for This Schedule		$9,921

Name and Address
(A)

Wayne McDearmon

3497 Binborok Road North
Columbus
OH
43227

Type or Classification
(B)

Janitor

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer
Total Non-Itemized Transactions with this Payee/Payer		$10,051
Total of All Transactions with this Payee/Payer for This Schedule		$10,051

Name and Address
(A)

Wentz, McInerney, Peifer & Petroff, LLC

3311 Bear Point Circle
Powell
OH
43065

Type or Classification
(B)

Legal Services

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$60,534
Total Non-Itemized Transactions with this Payee/Payer		$6,009
Total of All Transactions with this Payee/Payer for This Schedule		$66,543
Legal Services	01/27/2022	$9,619
Legal Services	03/11/2022	$13,113
Legal Services	04/20/2022	$13,791
Legal Services	04/21/2022	$18,559
Legal Services	06/29/2022	$5,452

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 19 - UNION ADMINISTRATION

FILE NUMBER: 040-094

Name and Address
(A)

James Mills
PO Box 714086

Cincinnati
OH
45271

Type or Classification
(B)

Video Production

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$14,920
Total Non-Itemized Transactions with this Payee/Payer		$1,112
Total of All Transactions with this Payee/Payer for This Schedule		$16,032
Video Production	11/18/2021	$14,920

Name and Address
(A)

Survey Monkey

32330 Collections Center Dr
Chicago
IL
60693

Type or Classification
(B)

Continuing Education

Purpose (C)	Date (D)	Amount (E)
Total Itemized Transactions with this Payee/Payer		$10,965
Total Non-Itemized Transactions with this Payee/Payer		$968
Total of All Transactions with this Payee/Payer for This Schedule		$11,933
Continuing Education - Survey	08/02/2021	$10,965

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

SCHEDULE 20 - BENEFITS

FILE NUMBER: 040-094

Description (A)	To Whom Paid (B)	Amount (C)
Total of all lines above (Total will be automatically entered in Item 55.)		$1,114,585
401k Profit Sharing Plan	AEGON USA	$391,223
Employee Insurance	United Healthcare	$444,547
Employee Insurance	Avidia Bank	$143,656
Employee Insurance	Anthem	$85,065
Employee Insurance	Principal Financial Group	$42,605
Employee Insurance	VSP - Vision Service Plan	$7,489

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)

69. ADDITIONAL INFORMATION SUMMARY

FILE NUMBER: 040-094

Question 17: The Organization experienced a fire at it's headquarters building during fiscal year 2022. The City of Columbus is holding a portion of the insurance proceeds in escrow until the building is demolished and any remediation required at the property is completed.

Question 10: Ohio Nurses Foundation (ONF) 3760 Ridge Mill Drive, Hilliard, Ohio 43026

Question 11(a): Ohio Nurses Association Political Contributing Entity (ONA PCE) 3760 Ridge Mill Drive Hilliard, Ohio 43026

Question 12: Blue & Co., LLC, Westerville, Ohio 43082

Schedule 13, Row1:

Schedule 13, Row1:Members Full Rate 100%

Schedule 13, Row1:

Schedule 13, Row1:

Schedule 13, Row2:

Schedule 13, Row2:Members Full Rate 50%

Schedule 13, Row2:

Schedule 13, Row2:

Schedule 13, Row3:

Schedule 13, Row3:Members Full Rate 25%

Schedule 13, Row3:

Schedule 13, Row3:

General Information:



Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)