LM-15 Trusteeship Report

FORM LM-15
TRUSTEESHIP REPORT

U.S. Department of Labor
Office of Labor-Management
Standards
Washington, DC 20210
For Official Use
Only

Form approved
Office of Management
and Budget
No. 1245-0003
Expires 01-31-2025

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. 461.

READ THE INSTRUCTIONS CAREFULLY BEFORE PREPARING THIS REPORT.

2. Type of Report
Initial (complete pages 1 through 4.)

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3. Date Trusteeship Established

Semiannual for period ending
(Complete pages 1 and 2 only.)
4. Labor Organization Held in Trusteeship
Affiliation or Organization Name
P.O. Box, Bldg. and Room No., if any

Designation (Local, Lodge, etc.)

Number and Street
Prefix

Number

R

Designation Number

Suffix

City
Unit Name (if any)

ZIP Code + 4

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State

5. Labor Organization Imposing the Trusteeship

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1. File Number of Labor
Organization Held in Trusteeship

Name
File Number

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P.O. Box, Building and Room Number, if any

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Number and Street

State

City

ZIP Code + 4
Add More Item 6 Information

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6. List the article(s) and section(s) of the constitution which specifically authorize imposition of the trusteeship:

Signatures

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Each of the undersigned, duly authorized officials of the labor organization imposing the trusteeship over 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 the section
on penalties in the instructions.)
President
(if other title,
see instructions.)

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24. Signed

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President

26. Signed

Trustee

On

Date

On
Telephone Number

Date
Treasurer
(if other title,
see instructions.)

25. Signed

Treasurer

Telephone Number

27. Signed

On

Trustee
(If other title,
see instructions.)

Trustee

On
Date

Form LM-15 (2003)

Trustee
(if other title,
see instructions.)

Telephone Number

Date
Print Report

Telephone Number
Page 1 of 4

File Number

Name of Labor Organization Held In Trusteeship

7. Check the reason(s) for establishing or continuing the trusteeship:
a. To correct corruption or financial malpractice.
b. To assure the performance of collective bargaining agreements or other duties of a bargaining representative.
c. To restore democratic procedures.

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d. Other.
Add More Item 8 Information

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8. Provide a detailed statement which explains each reason checked in Item 7, above.

9. During the period covered by this report
a. Did a convention or other policy-determining body meet to which the trusteed labor organization sent delegates or would have sent delegates if not in
trusteeship?
Yes
No
(if the answer is "Yes," complete and file Form LM-15A.)
b. Did the labor organization imposing the trusteeship hold an election of officers?
Yes
No
(If the answer is "Yes," complete and file Form LM-15A.)
Form LM-15 (2003)

Page 2 of 4

File Number

Name of Labor Organization Held In Trusteeship

Statement of Assets and Liabilities (Complete for Initial Report Only)
Assets as of Date Trusteeship Imposed
Amount

From
Sch. #

Item

10. Cash

18. Accounts Payable

11. Accounts Receivable

19. Loans Payable

12. Loans Receivable

6

20. Mortgages Payable

1

13. U.S. Treasury Securities

21. Other Liabilities

14. Investments

2

22. TOTAL LIABILITIES

15. Fixed Assets

5

23. NET ASSETS (Item 17 less Item 22)

16. Other Assets

3

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4

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17. TOTAL ASSETS

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Schedule 1 - Loans Receivable (See Instructions for Item 12)
(A) Name of officer, employee, member, or business
enterprise

Amount

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From
Sch. #

Item

Liabilities as of Date Trusteeship Imposed

(C) Amount

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(B) Purpose of loan, security, if any, and terms for repayment

Add More Schedule 1 Items

1.
2.
3.

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4. Total from additional pages (if any)
5. Total of loans not listed above

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6. Total of Lines 1 through 5

Schedule 2 - Investments (See Instructions for Item 14)
(A) Description

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Marketable Securities:
1. Total Cost

4.

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5.
6.
7. Total from additional pages (if any)

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(b)

1.

3.

3. List each marketable security that has a book value over $1,000 and
exceeds 20% of Line 2.
(a)

(B) Book Value

2.

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2. Total Book Value

Schedule 3 - Other Assets (See Instructions for Item 16)

(A) Description Add More Schedule 3 Items

(B) Amount

Add More Schedule 2 Items

(c) Total from additional pages (if any)

8. Total of Lines 1 through 7

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Other Investments:

Schedule 4 - Other Liabilities (See Instructions for Item 21)
(A) Description Add More Schedule 4 Items

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4. Total Cost

5. Total Book Value

1.
2.

6. List each other investment which has a book value over $1,000 and
exceeds 20% of Line 5. Also list each subsidiary or trust which is an
investment.

3.
4.

(a)

5.

(b)

6.

(c)Total from additional pages (if any)

7. Total from additional pages (if any)

7. Total of Lines 2 and 5
Form LM-15 (2003)

(B) Amount

0

8. Total of Lines 1 through 7
Page 3 of 4

File Number

Name of Labor Organization Held In Trusteeship

Schedule 5 - Fixed Assets (See instructions for Item 15)
(A) Description

(B) Cost or
Other Basis

Add More Schedule 5 Items

(C) Total
Depreciation
or Amount
Expensed

(D) Book
Value

(E) Fair
Market
Value

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1. Land (give location)

2. Total from additional pages (if any)

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3. Buildings (give location)

4. Total from additional pages (if any)
5. Automobiles and Other Vehicles
6. Office Furniture and Equipment

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7. Other Fixed Assets

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8. Total of Lines 1 through 7

Schedule 6 - Loans Payable (See Instructions for Item 19)
(A) Source

(B) Amount

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1.

Add More Schedule 6 Items

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2.

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3.

4.

5. Total from additional pages (if any)
6. Total of Lines 1 through 6

Form LM-15 (2003)

Page 4 of 4