FORM
LM-20 - AGREEMENT
& ACTIVITIES REPORT
OMB No. 1245-0003 . Expires 09-30-2021 .
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 D Penn
Title:Partner
Organization:THE CROSSROADS GROUP LABOR RELATION CONS
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:Laurie Haynes
Organization:Mission Hospital
Trade Name, if any:
P.O. Box., Bldg., Room No., if any:
Street:509 Biltmore Avenue
City:AshevilleState:NC
ZIP code:28801
7.
Date entered into03/11/2020

8.
Name of person(s) through whom made:
Name:Laurie Haynes
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.)
13.
SIGNED: Michael D Penn
Title: PRESIDENT
Date: Mar 26, 2020
Telephone Number: 818-999-5632
14.
SIGNED: Steven A Beyer
Title: TREASURER
Date: Mar 30, 2020
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 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 the hourly rate of $400 per hour plus reasonable and customary expenses
Specific Activities to be performed
Activity1
11. For each activity, separately list in detail the information required. (See instructions.)
a. Nature of activity:To assist the Employer with its communication efforts to inform employees of their Section 7 rights and provide them information regarding third-party representation
11.b.Period during which activities performed:
03/08/2020 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:Miko A 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
12.a. Identify subject groups of employees:
All RNs employed by the Employer at their hospital in Asheville, North Carolina
12.b. Identify subject labor organizations:
NNU
Form LM-20 (2003)