LM-3 Labor Organization Annual Report

Labor Organization and Auxiliary Reports

form_lm3_facsimile_2022

OMB: 1245-0003

Document [pdf]
Download: pdf | pdf
ed

U.S. Department of Labor
Office of Labor-Management Standards
Washington, DC 20210

FORM LM-3 LABOR ORGANIZATION ANNUAL REPORT

eq
ui
r

FOR USE ONLY BY LABOR ORGANIZATIONS WITH LESS THAN $250,000 IN TOTAL ANNUAL RECEIPTS

Form Approved
Office of Management and Budget
No. 1245-0003
Expires XX-XX-XXXX

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.

1. FILE NUMBER
Fro

2. PERIOD COVERED
MO
DAY
From

3. (a) AMENDED — If this is an amended report, check here:
YEAR

(b) HARDSHIP — If filing under hardship procedures, check here:

R

For Official Use Only

Through

(c) TERMINAL — If this is a terminal report, check here:

ng

8. MAILING ADDRESS (Type or print in capital letters.)

IMPORTANT

First Name

Last Name

If the label information is correct, leave Items 4 through 8 blank.

P.O. Box  Building and Room Number (if any)

Fi
li

Peel off the address label from the back of the package
.

on
ic

If any of the label information is incorrect, complete Items 4 through 8.
Number and Street
4. AFFILIATION OR ORGANIZATION NAME
5. DESIGNATION (Local, Lodge, etc.)

6. DESIGNATION NUMBER

tr

7. UNIT NAME (if any)

City

State

le
c

9. Are your organization’s records kept at its mailing address?
Yes
(If “No,” provide address in Item 56.)

ZIP Code + 4

-E

56. ADDITIONAL INFORMATION

No

m

ile

Item Number

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 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 VI on penalties in the instructions.)

Fa

cs
i

57. SIGNED: __________________________________________________________ PRESIDENT
(If other title,
/
/
(
)
—
see instructions.)
Date
Telephone Number
Form LM-3 (Revised 2016)

3-1

58. SIGNED: ____________________________________________________ TREASURER
(If other title,
/
/
(
)
—
see instructions.)
Date
Telephone Number
Page 1 of 4

ed

During the Reporting Period Did Your Organization:
Yes

No

10. Have a “subsidiary organization” as defined in
Section X of the instructions? .............................................

R

ng

12. Have a political action committee (PAC) fund? ..................

Fi
li

21. During the reporting period, did your
organization have any changes in its
Yes
constitution and bylaws (other than
rates of dues and fees) or in practices/
procedures listed in the instructions? ........................
(If the constitution and bylaws have changed,
attach two new dated copies. If practices/
procedures have changed, see the instructions.)

on
ic

13. Acquire or dispose of any goods or property in
any manner other than by purchase or sale? .....................

le
c

-E

16. Have any officer who was paid $10,000 or more
by your organization and also received $10,000 or
more as an officer or employee of another labor
organization or of an employee benefit plan? .....................

ile

m

(If the answer to any of the above questions is “Yes,” provide details
in Item 56 on page 1 as explained in the instructions for each item.)

cs
i

23. What are your organization’s rates of
dues and fees?
(Enter a minimum and maximum if more
than one rate applies for any line.)

Dues/Fees

18. Have loans totaling more than $250 to any officer,
employee, or member, or make any loans to a
business enterprise? ..........................................................

Fa

YEAR

Rates of Dues and Fees

17. Pay any employee salary, allowances, and other
expenses which, together with any payments
from affiliates, totaled more than $10,000? ........................

Form LM-3 (Revised 2016)

MO

No

22. What is the date of your organization’s
next regular election of officers?

tr

15. Discover any loss or shortage of funds or
other property? ...................................................................
(Answer “Yes” even if there has been repayment
or recovery.)

19. How many members did your
organization have at the end of the
reporting period?

20. What is the maximum amount
recoverable under your organization’s
fidelity bond for a loss caused by
any officer or employee of your
$
organization?

11. Create or participate in the administration of a
trust or other fund or organization, as defined
in the instructions, which provides benefits for
members or their beneficiaries? .........................................

14. Have an audit or review of its books and records
by an outside accountant or by a parent body
auditor/representative?.......................................................

—

eq
ui
r

FILE NUMBER:

3-2

Amount

Unit

(a) Regular Dues/Fees

$

per

(b) Initiation Fees

$

per

(c) Transfer Fees

$

per

(d) Work Permits

$

per

Page 2 of 4

Minimum

Maximum

(B) Title

(List all persons who held office during the reporting period even if
they received no salary or other disbursements. Use all capital letters.)
(Enter title of officer, such as PRESIDENT or TREASURER.)

Last Name

Status
(C)*

First Name

Gross Salary
(before taxes and
other deductions)
(D)

MI

Title

Status
MI

First Name

2.
Status

Last Name

First Name

MI

3.
Title

Status
First Name

4.
Title

MI

on
ic

Last Name

Fi
li

Title

Total
(F)

ng

Last Name

Allowances
and Other
Disbursements
(E)

—

R

1.

FILE NUMBER:

eq
ui
r

(A) Name

Enter Amounts in Dollars Only — Do Not Enter Cents

ed

24. ALL OFFICERS AND DISBURSEMENTS
TO OFFICERS

Status

Last Name

First Name

5.

Status

tr

Title

MI

First Name

le
c

Last Name

6.
Title

Status

First Name

-E

Last Name

MI

7.
Title

MI

Status

ile

8. Totals from additional pages (if any)

m

9. Totals of Lines 1 through 8

cs
i

10. Less Deductions

Enter the total from Line 11 in .............................................................................................. Item 45  11. Net Disbursements

Fa

*Code for Status (C): past officer — P; continuing officer — C; new officer during the reporting period — N.
Form LM-3 (Revised 2016)

3–3

(If any officer was not elected at a regular election in accordance with
your organization’s constitution and bylaws, explain in Item 56 on page 1.)
Page 3 of 4

ed

FILE NUMBER:

ASSETS

Start of Reporting Period End of Reporting Period
(A)

(B)

LIABILITIES
Item

32. Accounts Payable…..

26. Loans Receivable ......

33. Loans Payable………

27. U.S. Treasury Securities

34. Mortgages Payable…...

28. Investments………….

35. Other Liabilities……..

29. Fixed Assets…………

36. TOTAL LIABILITIES..

(D)

ng

30. Other Assets…………

37. NET ASSETS

(Item 31 less Item 36)…

CASH RECEIPTS

on
ic

31. TOTAL ASSETS…….

AMOUNT

CASH DISBURSEMENTS

AMOUNT

Item

38. Dues ...............................................................
39. Per Capita Tax ...............................................

le
c

40. Fees, Fines, Assessments & Work Permits…

45. To Officers (from Item 24) ………………….

tr

Item

46. To Employees (less deductions) …………..

47. Per Capita Tax ……………………………….
48. Office & Administrative Expense……………

42. Sale of Investments & Fixed Assets ...............

49. Professional Fees…………………………….

43. Other Receipts ...............................................

50. Benefits………………………………………..

44. TOTAL RECEIPTS .........................................

51. Contributions, Gifts & Grants………………..

ile

-E

41. Interest & Dividends .......................................

m

If total receipts reported in Item 44 are $250,000
or more, your organization must file Form LM-2
instead of this form.

cs
i

STATEMENT B
RECEIPTS AND DISBURSEMENTS

End of Reporting Period

(C)

R

25. Cash ..........................

Start of Reporting Period

Fi
li

STATEMENT A
ASSETS AND LIABILITIES

Item

—

eq
ui
r

Enter Amounts in Dollars Only — Do Not Enter Cents

Fa

Form LM-3 (Revised 2016)

52. Purchase of Investments & Fixed Assets….
53. Loans Made……………………………………
54. Other Disbursements…………………………
55. TOTAL DISBURSEMENTS………………….
3–4

Page 4 of 4

ed

ORGANIZATION NAME:

FILE NUMBER:

eq
ui
r

ENDING DATE OF PERIOD COVERED:

—

PAGE ____ OF ____ ADDITIONAL PAGES

Status

other deductions)

(C)

(D)

(Enter title of officer, such as PRESIDENT or TREASURER.)

Last Name

Gross Salary
(before taxes and

First Name

MI

Title

ng

(B) Title

(List all persons who held office during the reporting period even if
they received no salary or other disbursements. Use all capital letters.)

Status
First Name

Last Name

MI

Title

Fi
li

(A) Name

Status
First Name

Title

MI

on
ic

Last Name

Status

Last Name

First Name

Status

First Name

le
c

Last Name

tr

Title

MI

Title

Status

First Name

-E

Last Name

MI

Title

Status

First Name

ile

Last Name

MI

Title

m

Last Name

cs
i

Title

Fa

Form LM-3 (Revised 2016)

MI

Status
First Name

MI

Status

Totals
3 – I24

Allowances
and Other
Disbursements

Total

(E)

(F)

R

24. ALL OFFICERS AND DISBURSEMENTS TO OFFICERS (continued)

ed

ORGANIZATION NAME:

eq
ui
r

FILE NUMBER:
ENDING DATE OF PERIOD COVERED:

—

PAGE ____ OF ____ ADDITIONAL PAGES

Status

other deductions)

(C)

(D)

(Enter title of officer, such as PRESIDENT or TREASURER.)

Last Name

Gross Salary
(before taxes and

First Name

MI

Title

ng

(B) Title

(List all persons who held office during the reporting period even if
they received no salary or other disbursements. Use all capital letters.)

Status
First Name

Last Name

MI

Title

Fi
li

(A) Name

Status
First Name

Title

MI

on
ic

Last Name

Status

Last Name

First Name

Status

First Name

le
c

Last Name

tr

Title

MI

Title

Status

First Name

-E

Last Name

MI

Title

Status

First Name

ile

Last Name

MI

Title

m

Last Name

Fa

cs
i

Title

Form LM-3 (Revised 2016)

MI

Status
First Name

MI

Status

Totals
3 – I24

Allowances
and Other
Disbursements

Total

(E)

(F)

R

24. ALL OFFICERS AND DISBURSEMENTS TO OFFICERS (continued)


File Typeapplication/pdf
File TitleMicrosoft Word - Form LM-3_updated_3_7_16
Authoranddavis
File Modified2022-03-10
File Created2016-07-21

© 2024 OMB.report | Privacy Policy