FORM
LM-21 - RECEIPTS
& DISBURSEMENTS REPORT
OMB No. 1245-0003 . Expires 01-31-2025 .
IMPORTANT: 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. Required of persons, including Labor Relations Consultants and Other Individuals and Organizations, under Section 203(b) of the Labor-Management Reporting and Disclosure Act of 1959, as amended (LMRDA).
Office of Labor-Management Standards
U.S. Department of Labor
For Official Use Only
E
OLMS
Read the instructions carefully before completing this report.
1. File Number: C-69678      2. Period Covered by this report From: 01/01/2022 Through: 12/31/2022
A. Person Filing
3. Name and mailing address (including Zip Code):
Name:Tracy Lee Schrey
Title:Senior Consultant
Organization:Valens Business Services, LLC
P.O. Box., Bldg., Room No., if any:
Street:15421 Georgia Oak Place
City:Winter GardenState:FL
ZIP code:34787
4. Any other address where records necessary to verify this report are kept:
Name:Tracy B Schrey
Title:Senior Consultant
Organization:Valens Business Services, LLC
P.O. Box., Bldg., Room No., if any:PO Box 1529
Street:
City:Broken ArrowState:OK
ZIP code:74013
Signature and Verification
Each of the undersigned 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 VII on penalties in the instructions.)
17.
SIGNED: Tracy L Schrey
Title: PRESIDENT
Date: Apr 02, 2023
Telephone Number: 717-877-1376
18.
SIGNED: Tracy L Schrey
Title: TREASURER
Date: Apr 02, 2023
Telephone Number: 717-877-1376
Form LM-21 (2003)
B.
Statement of Receipts Report all receipts from employers in connection with labor relations advice or services regardless of the purposes of the advice or services.
C.
Statement of Disbursements Report all disbursements made by the reporting organization in connection with labor relations advice or services rendered to the employers listed in Part B.
7.
Disbursements to Officers and Employees:
(a) Name(b) Salary(c) Expense(d) Totals
8. Total disbursements to officers and employees:
9. Officer and Administrative Expenses:
10. Publicity:
11. Fees for Professional Services:
12. Loans Made:
13. Other Disbursements:
14. Total Disbursements (Sum of Items 8-13):
Form LM-21 (2003)
D.
Schedule of Disbursements for Reportable Activity Use this schedule to report only disbursements made for the purposes described in Part D of the instructions.
Form LM-21 (2003)