FORM
LM-20 - AGREEMENT
& ACTIVITIES REPORT
OMB No. 1245-0003 . Expires 08-31-2026 .
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.a. File Number: C-633
Amended:
2.
Name and mailing address (including Zip Code):
Name:Michael Dana Penn
Title:Partner
Organization:THE CROSSROADS GROUP LABOR RELATION CONSULTANTS
P.O. Box., Bldg., Room No., if any:505
Street:63 Via Pico Plaza
City:San ClementeState:CA
ZIP code:92672
3.
Other address where records necessary to verify this report are kept:
Name:
Title:
Organization:
P.O. Box., Bldg., Room No., if any:
Street:
City:State:
ZIP code:
4.
Date fiscal year ends:Dec /31
5.
Type of person
a. Individual       b. X Partnership
c. Corporation C d. Other
Specify:

  Nature of Agreement or Arrangement
6.
Full name and address of employer with whom made (include ZIP Code):
Name:Scott Edelman
Organization:Burke Rehabilitation Hospital
Trade Name, if any:
P.O. Box., Bldg., Room No., if any:
Street:785 Mamaroneck Avenue
City:White PlainsState:NY
ZIP code:10605
7.
Date entered into08/20/2024

8.
Name of person(s) through whom made:
Name:Scott Edelman
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 VIII on penalties in the instructions.)
13.
SIGNED: Michael D Penn
Title: PRESIDENT
Date: Sep 15, 2024
Telephone Number: 818-999-5632
14.
SIGNED: Steven A Beyer
Title: TREASURER
Date: Sep 16, 2024
Telephone Number: 949-248-0884
Form LM-20 (2003)
9.
Check the appropriate box(es) to indicate whether an object of the activities undertaken is directly or indirectly:
a.
X
To persuade employees to exercise or not to exercise, or persuade employees as to the manner of exercising, the right to organize and bargain collectively through representatives of their own choosing.
b.
To supply an employer with information concerning the activities of employees or a labor organization in connection with a labor dispute involving such employer, except information for use solely in conjunction with an administrative or arbitral proceeding or a criminal or civil judicial proceeding.
10.
Terms and conditions. (Explain in detail; see instructions. Written agreements must be attached.):
XWritten Agreement/Arrangement
Payment on a fee-for-service basis at an hourly rate of $450, plus reasonable and customary expenses. These services are not contemplated for any specific time and may be terminated by either party at any time.
Specific Activities to be performed
Activity1
11. For each activity, separately list in detail the information required. (See instructions.)
a. Nature of activity:Provide presentations, prepare written materials, and conduct meetings with management and employees to discuss information related to third-party representation and rights afforded by the National Labor Relations Act (NLRA)
11.b.Period during which activities performed:
09/25/2024 to Present
11.c. Extent of performance:
Continuing
11.d.
Name and address of person(s) through whom activities were performed or will be performed:
  Name:Michael Dana Penn         Organization:The Crossroads Group Labor Relations Consultants
  P.O. Box, Bldg., Room No., If any:Suite 505Street:63 Via Pico PlazaCity:San ClementeState:CAZip:92672
11.d.
Name and address of person(s) through whom activities were performed or will be performed:
  Name:Wildine Pierre Barrett         Organization:Bridge Labor Solutions
  P.O. Box, Bldg., Room No., If any:Street:931 N. SR 434City:Altamonte SpringsState:FLZip:32714
12.a. Identify subject groups of employees:
All employees employed by the Employer at its hospital in White Plains, NY
12.b. Identify subject labor organizations:
1199SEIU
Form LM-20 (2003)