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460 Pena 2018 from 10/21 to 12/31Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from 10/21 /18 through 12/31 /18 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Also Complete Part 5) 0 Sponsored (Also Complete Part 6) ❑ General Purpose Committee 0 Sponsored ❑ Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER 1370057 COMMITTEE TO ELECT JOHN PENA CITY COUNCIL 2018 STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE LA QUINTA CA 92253 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREACODE/PHONE OPTIONAL: FAX/E-MAIL ADDRESS 4. Verification RECEIVED Date of election if applil (Month, Day, Year) COVER PAGE I of For Official Use Only CITY OF LA QUINTA 11 /6/18 1ITY CLERK DEPARTMENIJ 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement W Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER GERRI LYNCH MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE LA QUINTA NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CA 92253 CITY STATE ZIP CODE AREACODE/PHONE OPTIONAL: FAX I E-MAIL ADDRESS I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjuly undo the laws of the State of California that the foregoing is true and rcrract. 1 Executed on � ,� By _ p q ru Traasur@r rRsSislnnlTrnaaurer Executed on } ) J By Da Slgna4ura or QQntnolittrrid.1 Tome, Star. Measufo Proponent or RenTmmlhla CM car of Sponsor Executed on DAIQ Executed on By By Signature of Controlling Moeholder, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE JOHN J. PENA OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IFAPPLICABLE) CITY COUNCIL CITY OF LA QUINTA RESIDENTIALBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP LA QUINTA, CA 92253 Related Committees Not Included in this Statement: List any committees not included in this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STRE ET ADDRE S S (NO P.O. BOX) COVER PAGE - PART 2 Page /- of 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) or candidate(s) for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Summary Page Amounts may be rounded to whole dollars. Statement covers period from 10/21 /18 SUMMARY PAGE SEE INSTRUCTIONS ON REVERSE through 12/31 /18 Page of NAME OF FILER I.D. NUMBER JOHN J. PENA 1370057 Contributions Received Column A TOTAL THIS PERIOD Column B CALENDAR Calendar Year Summary for Candidates (FROM ATTACHED SCHEDULES) YEAR TOTAL TO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions.. ..................... --- .................... schedule A, Line 3 $ 2419 $ 12093 500 750 1/1 through 6/30 7/1 to Date 2. Loans Received................................................................ schedule B, Line 3 2919 12843 20. ContributionsReceived 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 2 $ $ $ $ 4. Nonmonetary Contributions ............................................ schedule C, Line 3 0 6290 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED....................................Add Lines 3+4 $ 2919 $ 19133 Made $ $ Expenditures Made 6. Payments Made................................................................ schedule E, Line 4 $ 5169 $ 11789 7. Loans Made ............. ......................... ,: ..... :..... .:.................. schedule H, Line 3 0 0 8. SUBTOTAL CASH PAYMENTS .......................................... Add Lines 6 + 7 $ 5169 $ 11789 9. Accrued Expenses (Unpaid Bills) .......................................... schedule F Line 3 0 0 10. Nonmonetary Adjustment ................_....,.......... ...... ........... schedule C, Line 3 0 0 11. TOTAL EXPENDITURES MADE........................................Add Lines 8+9+10 $ 5169 $ 11789 Current Cash Statement 12, Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 2555 To calculate Column B, 13. Cash Receipts........................................................... Column A, Line 3 above 2919 add amounts in Column 14. Miscellaneous Increases to Cash .................................. schedule 1, Line 4 188 A to the correspondingamounts from Column B 15. Cash Payments ....................................... :........ ...._..... Column A, Line 6 above 5169 of your last report. Some amounts in Column A may 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ 493 be negative figures that should be subtracted from If this is a termination statement, Line 16 must be zero. previous period amounts. If this is the first report being 17, LOAN GUARANTEES RECEIVED ................................ schedule B, Part 2 $ 0 filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if Cash Equivalents and Outstanding Debts 0 any)' 18. Cash Equivalents ................................................ See instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $ 750 Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made' (If Sublect to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) $ $ Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A Amounts may be rounded SCHEDULE A Monetary Contributions Received ro wnoie sonars. Statement covers period CALIFORNIA 10/21 /18 from FORM through 12/31 /18 Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER LID, NUMBER JOHN J. PENA 1370057 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) El IND BUILDING INDUSTRY ASSOC. [I ❑ 10/30/18 TH � OTH 750 750 LOS ANGELES, CA 90071 ❑ PTY ❑ SCC m IND 11/1/18 KEN EDWARDS ❑COM RETIRED 200 200 El OTH LA QUINTA, CA 92253 ❑ PTY ❑ SCC ❑ IND CALIFORNIA VACATION VILLAS ❑COM 11/1/18 MOTH 500 500 NEWPORT BEACH, CA 92650 ❑ PTY ❑ SCC PALM COMMUNITIES ❑IND ❑ COM 12/5/18 91 OTH 100 100 IRVINE, CA 92618 ❑ PTY ❑ SCC ❑ IND ❑ COM BLACKHAWK FUNDING 11 /8/18 W1 OTH 200 200 La Quinta, CA ❑ PTY ❑ SCC SUBTOTAL $ 1750 Schedule A Summary 1. Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.).........................................................................................................$ 2. Amount received this period — unitemized monetary contributions of less than $100 ........................... $ 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.).... ,................. TOTAL $ *Contributor Codes IND — Individual 1750 COM — Recipient Committee (other than PTY or SCC) 669 OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee 2419 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Amounts maw he rounded SCHEDULE B - PART 1 Schedule - Part 1 to whole dollars. Statement covers period Loans Received 10/21/18 CALIFORNIA , , - ■ from , SEE INSTRUCTIONS ON REVERSE through 12/31/18 Page of NAME OF FILER I.D. NUMBER JOHN J. PENA 1370057 FULL NAME, STREETADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OUTSTANDING AMOUNT (�) AMOUNT PAID OUTSTANDING INTEREST ORIGINAL CUMULATIVE OF LENDER (IF COMMITTEE, ALSO ENTER to NUMBER) (IF SELF-EMPLOYED, ENTER BALANCE BEGINNING THIS RECEIVED THIS PERIOD OR FORGIVEN* BALANCE AT CLOSE OF THIS PAID THIS AMOUNT OF CONTRIBUTIONS NAME OF BUSINESS) PERIOD THIS PERIOD PERIOD PERIOD LOAN TO DATE JOHN PENA JOHN PENA ASSOC [I PAID CALENDAR YEAR $ 0 $ 750 0 y, $ 250 $ 750 ❑ FORGIVEN PER ELECTION" LA QUINTA, VA 92253 RATE $ 250 $ 500 $ 0 6/30/19 $ 750 12/5/18 $ 750 t IND ❑ COM El OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR g $ k $ $ ❑ FORGIVEN PER ELECTION" RATE t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC $ $ $ $ DATE INCURRED $ DATE DUE ❑ PAID CALENDARYEAR FORGIVEN El FORGIVEN PER ELECTION' t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC $ $ $ $ $ DATE DUE DATE INCURRED SUBTOTALS $ 500 $ 0 $ 750 $ 750 Schedule B Summary 1. Loans received this period.....................................................................................................................$ inn (Total Column (b) plus unitemized loans of less than $100.) 2. Loans paid or forgiven this period ...... ........................................... --- ................................................. -$ n (Total Column (c) plus loans under $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 3. Net change this period. (Subtract Line 2 from Line 1.)................................... :::::.:......... :.......... NET $ n Enter the net here and on the Summary Page, Column A, Line 2. (May be a negative number) (Enlnr [e) an Schedule E, Line 3) tContributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee 'Amounts forgiven or paid by another party also must be reported on Schedule A. FPPC Form 460 (Jan/2016) " If required. FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Amounts may be rounded Statement covers period Payments Made to whole dollars. 10/21/18 from SEE INSTRUCTIONS ON REVERSE JOHN J. PENA through 12/31 /18 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. Page I of I.D. NUMBER 1370057 CMP campaign paraphernalia/misc. MBR member communications RAID radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)' OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)" POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I D NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID FORTUN'S FND LA QUINTA, CA 2000 DESERT PROMOTIONS CMP 2063 Cathedral City, CA 92234 BRIGHT RENTALS THOUSAND PALMS, CA FND " Payments that are contributions or independent expenditures must also be summarized on Schedule D. Schedule E Summary SUBTOTAL$ 206 4269 1. Itemized payments made this period. Include all Schedule E subtotals. .......... $ 5169 2. Unitemized payments made this period of under$100..........................................................$ 0 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).)..................... ................ $ 0 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.)........................... TOTAL $ 5169 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E (Continuation Sheet) Payments Made Amounts may be rounded to whole dollars. SCHEDULE E (CONT.) Statement covers period from 10/21/18 ■ SEE INSTRUCTIONS ON REVERSE 12/31 /18 throughPage ` of NAME OF FILER I.D. NUMBER JOHN J. PENA 1370057 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)• OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)` POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (intemet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID HELEN CARLSON INDIAN WELLS, CA LIT 600 LUNA INK PALM DESERT, CA CMP 300 Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 900 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov S -hpriillP_ I _ .....A_,. SCHEDULE I Miscellaneous Increases to Cash to whole dollars. Statement covers period p from 10/21/18 q--L SEE= INSTRUCTIONS ON REVERSE through . 12/31/18 Pageof _ NAME OF FILER I D. NUMBER JOHN J. PENA 1370057 DATE RECEIVED FULL NAME AND ADDRESS OF SOURCE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) DESCRIPTION OF RECEIPT I` AMOUNT OF INCREASE TO CASH CITY OF LA QUINTA REFUND OF DEPOSIT 12/21/18 LA QUINTA, CA 92253 188 Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 188 Schedule I Summary Itemized Increases to cash this period. .... .$ 188 1 2. Unitemized increases to cash of under $100 this period. $ 0 3. Total of all interest received this period on loans made to others. (Schedule H, Column (e).) ...............$ 0 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Line 14.).................................................................... ... • ..................... TOTAL $ 188 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov