Public reporting burden for this collection of information is estimated to average approximately 9 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. Reporting of this information is mandatory and is required by the Labor

- Management R eporting and Disclosure Act of 1959, as amended, for the purpose of public disclosure. As this is public information, there are no assurances of confidentiality. If you have any comments regarding this estimate o r any other aspect of this information colle ction, including suggestions for reducing this burden, please send them to the U.S. Department of Labor, Office of Labor

- Management Standards, Division of Interpretations and Standards, Room N

- 560 9 , 200 Constitution Avenue, NW, Washington, DC 20210.



# INST RUCTIONS FOR FORM LM

- 4 LABOR ORGANIZATION ANNUAL REPORT

GENERAL INSTRUCTIONS

I. W HO 

### M UST 

### F ILE

Every labor organization subject to the Labor

- Management Reporting and Disclosure Act of 1959, as amended (LMRDA), the Civil Service Reform Act (CSRA), or th e Foreign Service Act (FSA) must file a financial report, Form
LM

- 2, LM

- 3, or LM

- 4, each year with the Office of Labor

Mana gement Standards (OLMS) of the U.S. Department of Labor. These laws cover labor organizations that represent employees who work in pr ivate industry, employees of the U.S. Postal Service, and most Federal government employees. Labor organizations that represent or include only state, county, or municipal government employees are not covered by these laws and, therefore, are not required to file. If you have a question about whether your organization is required to file, contact the nearest OLMS field office listed at the end of these instructions.



### II. W HAT 

### F ORM 

### T O 

### F ILE

Labor organizations with total annual receipts of less than $10,000 ma y file the abbreviated 2

- page annual report Form LM

- 4, if not in trusteeship as defined in Section VIII of these instructions. The term “total annual receipts” means all financial receipts of the labor organization during its fiscal year, regardless of the source, including receipts of any subsidiaries and any special funds.
Labor organizations with $10,000 or more in total annual receipts cannot use Form LM

- 4. These labor organizations must file either Form LM

- 3 or Form LM

- 2. For information on these forms , visit www.olms.dol.gov

, e

- mail olms

- public@dol.gov , or contact any of the offices
listed at the end of these instructions.



### III. W HEN 

### T O 

### F ILE

Form LM

- 4 must be filed with in 90 days after the end of your organization’s fiscal year (12

- month reporting period). The law does not authorize the U.S. Department of Labor to grant an extension of time for filing reports for any reason. The penalties for delinquency are described
in Section VI of these instructions.

If your organization went out of existence during its fiscal year, a terminal financial report must be filed within 30 days after the date it ceased to exist. See Section X of these instructions for information on filing a terminal financial report.



### IV. H OW 

### T O 

### F ILE

Form LM

- 4 must be submitted electronically to the Department. Form LM

- 3 filer s will be able to file report s in paper format only if they assert a temporary hardship exemption.

If you have difficulty navigating the software, or have questions about its functions and features, call the OLMS Help Desk at: (866) 401

- 1109. For questions concerning the reporting requirements, please send an e

- mail to OLMS

- Public@dol.gov or c all (202) 693

- 0123

. TEMPORARY HARDSHIP EXEMPTION:

If a labor organization experiences unanticipated technical difficulties that prevent the timely preparation and submission of an electronic filing, the organization may assert a temporary hardship exempti on to prepare and

s ubmit Form LM

- 4 in paper format by the required due date. An electronic format copy of the filed paper format document shall be submitted to the Department within ten business days after the required due date. Unanticipated technical dif ficulties that may result in additional delays should be brought to the attention of the OLMS Division of Interpretations and Standards, which can be reached at the address below, by email at OLMS

- Public@dol.gov , by phone at ( 202 ) 693

- 0123, or by fax at 20 2

- 693

- 1340.

Note: If either the paper filing or the electronic filing is not received in the timeframe specified above, the report will be considered delinquent.

### V. P UBLIC 

### D ISCLOSURE

The LMRDA requires that the U.S. Department of Labor make labor org anization financial reports available for inspection by the public. Reports for the year 2000 and later may be viewed and downloaded from the OLMS Online
Public Disclosure Room at www.unionreports.gov . Copies of reports and union constitutions and bylaws can be ordered at the same Web site. Reports may also be examined and copies purchased at the OLMS Public
Disclosure Room at :
U.S. Department of Labor Office of Labor

- Management Standards 200 Constitution Avenue, NW
Room N

- 1519 Washington, DC 20210

- 0001
T elephone: ( 202 ) 693

- 0125



### VI. O FFICER 

### R ESPONSIBILITIES 

### A ND 

### P ENALTIES

The president and treasurer or the corresponding principal officers of the labor organization required to sign Form LM

- 4 are personally responsible for its filing and accuracy. Under the L MRDA, officers are subject to criminal penalties for willful failure to file a required report and for false reporting. False reporting includes making any false statement or misrepresentation of a material fact while knowing it to be false, or knowingly f ailing to disclose a material fact in a required report or in the information required to be contained in it or in any information required to be submitted with it.

The reporting labor organization and the officers required to sign Form LM

- 4 are also subj ect to civil prosecution for violations of the filing requirements. Section 210 of the LMRDA (29 U.S.C. 440) provides that “whenever it shall appear that any person has violated or is about to violate any of the provisions of this title, the Secretary may bring a civil action for such relief (including injunctions) as may be appropriate.”

Under the CSRA and FSA and implementing regulations, false reporting and failure to report may result in administrative enforcement action and litigation. The officers res ponsible for signing Form LM

- 4 are also subject to criminal penalties for false reporting under S ection s 1001 of Title 18 and 1746 of Title 28 of the United States Code.



### VII. R ECORDKEEPING

The officers required to file Form LM

- 4 are responsible for
maintai ning records which will provide in sufficient detail the information and data necessary to verify the accuracy and completeness of the report. The records must be kept for at least 5 years after the date the report is filed. Any record necessary to verify, explain, or clarify the report must be retained, including, but not limited to, vouchers, worksheets, receipts, and applicable resolutions , and any electronic documents, including recordkeeping software, used to complete, read, and file the report

. 

### VIII. L ABOR 

### O RGANIZATIONS 

### I N 

### T RUSTEESHIP

Any labor organization which has placed a subordinate labor organization in trusteeship is responsible for filing the subordinate’s annual financial report. A trusteeship is defined in section 3(h) of the LMRDA as “any

re ceivership, trusteeship, or other method of supervision or control whereby a labor organization suspends the autonomy otherwise available to a subordinate body under its constitution or bylaws.”

Annual financial reports filed for any labor organization in trusteeship must be filed on Form LM

- 2 rather than Form
LM

- 4. The report must be signed by the president and treasurer or corresponding principal officers of the labor organization which imposed the trusteeship and by the trustees of the subordinate labor organization. Form LM

2 can be downloaded from the OLMS Web site at www.olms.dol.gov . For additional information contact any of the offices listed at the end of these instructions

. 

### IX. C OMPLETING 

### F ORM 

### LM

- 4

M ost pag es have a “ Save and Calculate ” button to total and transfer data to fields in various parts of the form. You may click on one or more of these buttons as you fill out the form at any time.

You should click on the “Validate Form ” button at any time to check for errors. This action will generate a

“ Validation Summary Page” listing any errors that will need to be corrected before you will be able to sign the form. Clicking on the signature lines will also perform the validation function.



## ITEMS 1

- 21

Answer I tems 1 through 21 as instructed. Select the appropriate box for those questions requiring a “Yes” or “No” answer; do not leave both boxes blank. Enter a single “0” in the boxes for items requiring a number or dollar amount if there is nothing to report.

1. FILE NUMBER

— The software will enter the labor organization’s 6

- digit file number here an d at the top of each page of Form LM

- 4. This is the number you entered when you downloaded Form LM

- 4. If the number is incorrect, you must download another copy of t he form using the correct number. If the labor organization does not have the number on file and cannot obtain the number from prior reports filed with the Department

, the number can be obtained from the OLMS Online Public
Disclosure Room at www.unionreports.gov or by contacting the nearest OLMS field office listed at the end of these instructions

. 2. PERIOD COVERED

— The software will enter the beginning and ending dates of the period covered by this

2report. These are the dates you entered when you
started a new Form LM

- 4. If the dates are incorrect, you

must either delete this form and start again, or contact
the OLMS Help Desk at (866) 401

- 1109 for assistance

. If the labor organization changed its fiscal ye ar, the ending date in Item 2 should be the labor organization’s new fiscal year ending date and the labor organization
should indicate in Item 19 (Additional Information) that the report is for a period of less than 12 months because its fiscal year has c hanged. For example, if the labor organization’s fiscal year ending date changes from June 30 to December 31, a report must be filed for the partial year from July 1 to December 31. Thereafter, the labor organization’s annual report should cover a full 12

- month period from January 1 to December 31.

3. AMENDED , HARDSHIP EXEMPTED, OR TERMINAL REPORT

— Do not complete this item unless the report
is an amended , hardship exempted, or terminal report

. Select Item 3(a) if the labor organization is filing an
amende d report correcting a previously filed report

. Select Item 3(b) if the labor organization is filing under the hardship exemption procedures defined in Section
IV. Select Item 3( c ) if the labor organization has gone out of business by disbanding, merging in to another labor organization, or being merged and consolidated with one or more labor organizations to form a new labor organization, and this is the labor organization’s terminal report. Be sure the date the labor organization ceased to
exist is entered in Item 2 (Period Covered) after the word “Through.” See Section X of these instructions for more information on filing a terminal report.

4. AFFILIATION OR ORGANIZATION NAME

— The software will access this information from the OLMS
database and enter the name of the national or international labor organization that granted the labor organization a charter. “Affiliates,” within the meaning of these instructions, are labor organizations chartered by the same parent body, governed by the same constitution and bylaws, or having a relationship of parent and subordinate. For example, a parent body is an affiliate of all its subordinate bodies, and all subordinate bodies of the same parent body are affiliates of each other.

If the labor organization has no t report ed such an affiliation, the software will enter the name of the labor organization as currently identified in the labor organization’s constitution and bylaws or other organizational documents.

This item cannot be edited. If the labor organization
needs to change this inform ation, contact OLMS at (202)
693

- 0124.

5. DESIGNATION

— The software will e nter the designation that specifically identifies the labor organization, such as Local, Lodge, Branch, Joint Board, Joint Council, District Council, etc. This fi eld cannot be
edited.

6. DESIGNATION NUMBER

— The software will enter
the number or other identifier, if any, by which the labor organization is known. This field cannot be edited.

7. UNIT NAME

— The software will enter any additional or alternate name by which the labor organization is known, such as “Chicago Area Local.” This field cannot
be edited.

8. MAILING ADDRESS

— The software will enter the current address where mail will most surely and quickly
reach the labor organization. T he first and last name of the person, if any, to whom such mail should be sent and any building and room number should be included

. These fields are pre

- filled from the OLMS database but can be edited by the filer.

9. CHANGES IN CONSTITUTION AND BYLAWS OR PRACTICES/PROCEDURES

— If the labor organization
answered “Yes” to Item 9 because the labor organization ’s constitution and bylaws were changed during the reporting period (other than rates of dues and fees), a dated cop y of the new constitution and bylaws
must either be submit ted as an electronic attachment to the Form LM

- 4 the labor organization submits to OLMS

, or the labor organization may submit a dated copy of the new constitution and bylaws to:

Office of Labor

- Management Standards 200 Constitution Ave., NW, Room N

- 1519 Wa shington, DC 20210

- 0001

If the labor organization is governed by a uniform constitution and bylaws prescribed by the labor organization’s parent national or international body, the labor organization’s parent body may file the constitution and bylaws on th e labor organization’s behalf. If the parent body files a constitution and bylaws on the labor organization’s behalf, answer Item 9 “Yes” and state that fact in Item 19 (Additional Information)

. If Item 9 is answered “Yes” because the labor organization ch anged any of the practices/procedures listed below during the reporting period and the practices/ procedures are not described in the labor organization’s constitution and bylaws, the labor organization must file an amended Form LM

- 1 (Labor Organization In formation Report) with its Form LM

- 4 to update information on file with OLMS :

• qualifications for or restrictions on membership;

• levying assessments;

• participating in insurance or other benefit plans;

• authorizing disbursement of labor organization funds;

3• au diting financial transactions of the labor organization;

• calling regular and special meetings;

• authorizing bargaining demands;

• ratifying contract terms;

• authorizing strikes;

• disciplining or removing officers or agents for breaches of their trust;

• imposing fines and suspending or expelling members including the grounds for such action and any provision made for notice, hearing, judgment on the evidence, and appeal procedures;

• selecting officers and stewards and any representatives to other bodies composed of labor organizations’ representatives;

• invoking procedures by which a member may protest a defect in the election of officers (including not only procedures for initiating an election protest but also all procedures for subsequently appealing an adverse de cision, e.g., procedures for appeals to superior or parent bodies, if any); and

• issuing work permits.

Form LM

- 1 can be downloaded from the OLMS Web site

at www.olms.dol.gov . If you are unable to download the form, contact any of the offices listed at the end of these instructions to obtain a copy.

NOTE: Federal employee labor organizations subject solely to the Civil Service Reform Act or Foreign Service Act are not required to submit an amended Form LM

- 1 to describ e revised or changed practices/procedures.

10. CHANGES IN RATES OF DUES AND FEES

— Answer Item 10 “Yes” if the labor organization changed its rates of dues and fees during the reporting period. If Item 10 is answered “Yes,” report the rates of dues and fee s in Item 19 (Additional Information) . If more than one rate applies, report the minimum and maximum rates. Also report the calendar basis for payment (per month, per year, etc.).

Dues and fees include initiation fees charged to new members, fees (other th an dues) from transferred members, fees for work permits, and regular dues or fees. Include only the dues and fees of regular members and not the dues and fees of members with special rates, such as apprentices, retirees, or unemployed members.

Answer “No” if the labor organization did not change its rates of dues and fees during the reporting period. 11. LOSSES OR SHORTAGES

— Answer Item 11 “Yes” if any loss or shortage of funds or other property of the
labor organization was discovered during the reportin g period whether or not there has been repayment or an agreement to make restitution. If Item 11 is answered “Yes,” describe the loss or shortage in detail in Item 19 (Additional Information) including such information as the amount of the loss or shortage of funds or a description of the property that was lost, how it was lost, and to what extent, if any, there has been an agreement to make restitution or any recovery by means of repayment, fidelity bond, insurance, or other means. Answer “No” if
no losses or shortages were discovered.

12. FIDELITY BOND

— Answer Item 12 “Yes” if the
labor organization was insured by a fidelity bond against losses through fraud or dishonesty during the reporting period. If Item 12 is answered “Yes,” enter the maximum

amount recoverable for a loss caused by any officer, employee, or agent of the labor organization who
handled the labor organization’s funds. Answer “No” if
the labor organization was not insured by a fidelity bond during the reporting period.

NOTE: Section 502(a ) of the LMRDA requires every officer, employee, or agent of a labor organization (which has property and annual financial receipts over $5,000 in value) who handles funds or other property of the organization to be bonded. The amount of the bond must
be a t least 10% of the value of the funds handled by the individual during the last reporting period. The bond must be obtained from a surety company approved by the Secretary of the Treasury. I f you have any questions or need more information about bonding re quirements, contact the nearest OLMS field office listed at the end of
these instructions.

13. NUMBER OF MEMBERS

— Enter the number of
members in the labor organization at the end of the reporting period. Include all categories of members who pay dues. Do not include nonmember employees who make payments in lieu of dues as a condition of employment under a union security provision in a collective bargaining agreement.

14. ASSETS

— Enter the total value of all the labor organization’s assets at the end of th e reporting period including, for example, cash on hand and in banks, property, loans owed to the labor organization, investments, office furniture, automobiles, and anything else owned by the labor organization. Enter “0” if the
labor organization had no assets at the end of the reporting period.

15. LIABILITIES

— Enter the total amount of all the labor organization’s liabilities at the end of the reporting period including, for example, unpaid bills, loans owed, total amount of mortgages owed, and other d ebts of your organization. Enter “0” if the labor organization had no liabilities at the end of the reporting period.

416. RECEIPTS

— Enter the total amount of all receipts of
the labor organization during the reporting period including, for example, dues, fees, fines, assessments, interest, dividends, rent, money from the sale of assets, and loans received by the labor organization. Also include payments in lieu of dues received from any nonmember employees as a condition of employment
under a union securit y provision in a collective bargaining agreement. Enter “0” if the labor organization had no receipts during the reporting period.

NOTE: If the labor organization’s annual receipts were $10,000 or more, the labor organization is not eligible to file Form L M

- 4 and must report on Form LM

- 2 or Form
LM

- 3 as explained in Section Il of these instructions.

17. DISBURSEMENTS

— Enter the total amount of all disbursements made by the labor organization during the reporting period including, for example, net payments to officers and employees, per capita tax and any other fees or assessments which the labor organization paid to any other organization, payments for administrative expenses, loans made by the labor organization, and taxes paid. Enter “0” if the labor orga nization made no disbursements during the reporting period.

18. PAYMENTS TO OFFICERS AND EMPLOYEES

— Enter the total amount of all payments to officers and employees made by the labor organization during the reporting period. The amount should include, for example, gross salaries (before tax withholdings and other payroll deductions); lost time pay; monthly, weekly, or daily allowances; and disbursements for conducting official business of the labor organization as well as
disbursements which were essential ly for the personal benefit of the officer or employee. Enter “0” if the labor organization made no payments to officers or employees during the reporting period.

NOTE: Section 503(a) of the LMRDA prohibits labor organizations from making direct or indirec t loans to any officer or employee of the labor organization which results in a total indebtedness on the part of such officer or employee to the labor organization in excess of $2,000 at any time.

19. ADDITIONAL INFORMATION

— Use Item 19 to provide additi onal information as indicated in Items 9, 10, 11, 20, and 21 and in Section X of these instructions. Enter the number of the item to which the information
relates in the Item Number column if the software has not
entered the number.

20

- 21. SIGNATURES

— T he completed Form LM

- 4 which is filed with OLMS must be signed by both the president and treasurer

, or corresponding principal officers

, of the labor organization. If the duties of the principal executive or principal financial officer are performed by an officer other than the president or treasurer, the report may be signed by the other officer. If the report is signed by an officer other than the president or treasurer, enter the correct title in the title field next to
the signature and explain in Item 19 (Additional Information) why the president or treasurer did not sign the report.

Before signing the form, c lick the Validate button at the top of page one to ensure that the report passes
validation and thus can be signed and submitted

. To electronical ly sign the form, click the signature spaces provided. E nter the date the report was signed and the telephone number at which the signatories conduct official business; you do not have to report a private, unlisted telephone number.

For a form that is prin ted and mailed to OLMS

, have the officers sign it manually and mail it to the Office of Labor

Management Standards, 200 Constitution Ave., NW,
Room N

- 1519 , Washington, DC 20210

- 0001. Original signatures are required on the printed Form LM

- 4 filed with OLMS ; stamped or mechanical signatures are not acceptable. If the duties of the principal executive or principal financial officer are performed by an officer other than the president or treasurer, the report may be signed by the other officer. If the report i s signed by an officer other than the president or treasurer, cross out the printed title, enter the correct title in Item 20 or 21, and explain in Item 19 (Additional Information) why the president or treasurer did not sign the report. Enter the date the report was signed and the telephone number at which the signatories conduct official business; you do not have to report a private, unlisted telephone number.



### X. L ABOR 

### O RGANIZATIONS 

### W HICH 

### H AVE 

### C EASED 

### T O 

### E XIST

If the labor organization has gone out of exist ence as a reporting labor organization, the last president and treasurer or the officials responsible for winding up the affairs of the labor organization must file a terminal financial report for the period from the beginning of the fiscal year to the dat e of termination. A terminal financial report must be filed if the labor organization has gone out of business by disbanding, merging into another organization, or being merged and consolidated with one or more labor organizations to form a new labor

organ ization. A terminal financial report is not required if
the labor organization changed its affiliation but continues to function as a separate reporting labor organization.

The terminal financial report may be filed on Form LM

- 4 if the labor organization f iled its previous annual report
on Form LM

- 4 and the labor organization’s total annual receipts, as defined in Section II of these instructions, were less than $10,000 for the part of the last fiscal year during which the labor organization existed. (If to tal annual receipts were $10,000 or more, the labor organization must use Form LM

- 2 or LM

- 3 to file its terminal financial report as explained in Section II of

5these instructions.) T he labor organization’s terminal financial report may be filed electronica lly using EFS or may be printed, manually signed, and submitted to the U.S. Department of Labor, Office of Labor

- Management Standards, 200 Constitution Avenue, NW, Room N

- 1519

, Washington, DC 20210

- 0001 , within 30 days after the date of termination.

To com plete a terminal report on Form LM

- 4, follow the instructions in Section IX and, in addition:

• Enter the date your organization ceased to exist in Item

2 (Period Covered) after the word “Through.”

• Select Item 3(b) indicating that your organization

ceased t o exist during the reporting period and that this is your organization’s terminal Form LM

- 4.

• Enter “3(b) ” in the Item Number column in Item 19

(Additional Information) and provide a detailed statement of the reason the labor organization ceased
to exist. A lso report in Item 19 plans for the disposition of the labor organization’s cash and other assets, if any (for example, transfer of cash and assets to the parent body). Provide the name and address of the person or organization that will retain the records of the terminated organization. If your organization merged with another labor organization, give that organization’s name, address and 6

- digit file number.

Contact the nearest OLMS field office listed below if you have questions about filing a terminal r eport.

OLMS Field Offices

Staff is available to answer questions at OLMS offices in the following cities.

Atlanta, GA Birmingham, AL Boston, MA Buffalo, NY Chicago, IL Cincinnati, OH Cleveland, OH Dallas, TX Denver, CO Detroit, MI Fort Lauderdale, FL
Honol ulu, HI Kansas City, MO Los Angeles, CA Milwaukee, WI Minneapolis, MN Nashville, TN New Orleans, LA New York, NY
Phil a de l phia, PA Phoenix, AZ Pittsburgh, PA St. Louis, MO San Francisco, CA Seattle, WA Tampa, FL Washington, DC

Consult local telephone direct ory listings under United States Government, Labor Department, Office of Labor

Management Standards, for the address and phone number of your nearest field office. Contact information for OLMS field offices is also available on the OLMS
Web site at www.olms.dol.gov

.



### Revised XX /201 5

6