LM-10 Employer Report

U.S. Department of Labor Office of Labor-Management

Standards

Washington, DC 20210

Form approved Office of Management

and Budget No. 1245-0003

Expires 08/31/2026

FORM LM-10

EMPLOYER REPORT

For Official Use Only

E

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

Part A

1. File Number E-				2. Fiscal Year Covered From:	MonthIDayIYear (mmIddIyyyy)		Through:	MonthIDayIYear (mmIddIyyyy)
					I	I		I	I
3. Name and address of Reporting Employer (inc. trade name, if any).				4. Name and address of President or corresponding principal officer, if different from address in Item 3. Name__________________________________________________ P.O. Box, Building and Room Number, If any___________________ Street__________________________________________________ City____________________________________________________ State______________________________ ZIP Code + 4__________
Employer________________________________________________
Trade Name_____________________________________________ Employer Identification Number______________________________
Attention To_____________________________________________
Title___________________________________________________
Mailing Address
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				6. Indicate by checking the appropriate box or boxes where records necessary to verify this report will be available for examination. Address in Item 3 Address in Item 4 Address in Item 5
available for examination.
Name__________________________________________________
Title____________________________________________________
Organization_____________________________________________
P.O. Box, Building and Room Number, If any______________________
Street____________________________________________________
City_______________________________________________________
State_______________________________ ZIP Code + 4___________
7. Type of organization. Corporation	Partnership	Individual	Other (specify)

On

Date ^{Telephone Number}

Signatures

Form LM-10 - Part A (XXXX) Page 1 of 3

Part A, Continued

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:

1. 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?

2. 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?

3. 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?

4. 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?

5. 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?

6. 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 NO

YES NO

YES NO

YES NO

YES NO

YES NO

If "Yes", number of Part Bs attached

TOTAL NUMBER OF PART Bs FOR THIS REPORT IS

Form LM-10 - Part A (XXXX), Continued

Page 2 of 3

Part B

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

ITEM 8.f

9.a. Agreement Payment Both		9.c. Position in labor organization or with employer (if an independent labor consultant, so state).
9.b. Name and address of person with whom or through whom a separate agreement was made or to whom payments were made. Name______________________________________________________ P.O. Box, Building and Room Number, if any________________________ Street________________________________________________________ City________________________________________________________ State_______________________________ ZIP Code + 4____________		9.d. Name and address of firm or labor organization with whom employed or affiliated. Organization_________________________________________________ Employer Identification Number________________________________ P.O. Box, Building and Room Number, if any________________________ Street________________________________________________________ City________________________________________________________ State_______________________________ ZIP Code + 4____________
10.a. Date of the promise, agreement, or arrangement pursuant to which payments or expenditures were agreed to or made.		10.b. The promise, agreement, or arrangement was: Oral 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)
12a. Explain fully the circumstances of all payments, including the terms of any oral agreement or understanding pursuant to which they were made. 12.b. If your Part B applies to Items 8.b - 8.f., did the payments or agreements concern employees performing work pursuant to a Federal contract or subcontract?

Form LM-10 - Part B (XXXX)

Page 3 of 3