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700 Pena 20151 CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION A PUBLIC DOCUMENT Please type or print in ink. • STATEMENT OF ECONOMIC INTElTSI:FP\«i COVER PAGE 36 ,. FAR Received at Only 3 1 .,1 9: L.5 Vi NAME OF FILER (LAST) PENA (FIRST) JOHNjlTti` ,_ft a,/ �t ei°i i ri . Aa r>1'11I' 1. Office, Agency, or Court Agency Name (Do not use acronyms) CITY OF LA QUINTA Division, Board, Department, District, if applicable Your Position COUNCILMEMBER ► If filing for multiple positions, list below or on an attachment. (Do not use acronyms) Agency: — Position. 2. Jurisdiction of Office (Check at least one box) ❑ State ['Judge or Court Commissioner (Statewide Jurisdiction) ❑ Multi -County ❑ County of ❑ Other City of LA QUINTA 3. Type of Statement (Check at least one box) ▪ Annual: The period covered is January 1, 2015, through ❑ Leaving Office: Date Left —J_/ December 31, 2015. (Check one) -or- The period covered is _J_/ , through 0 The period covered is January 1, 2015, through the date of leaving office. -or- p The period covered is _J_/ , through the date of leaving office. ❑ Candidate: Election year and office sought, if different than Part 1 December 31, 2015. ❑ Assuming Office: Date assumed _/_/ 4. Schedule Summary (must complete) ► Total number of pages including this cover page: —fa-- Schedules fa_Schedules attached ❑ Schedule A-1 - Investments - schedule attached • Schedule A-2 - Investments -. schedule attached • Schedule B - Real Property - schedule attached -or- ▪ None - No reportable interests on any schedule 1-34 Schedule C - Income, Loans, & Business Positions - schedule attached Schedule D - Income - Gifts - schedule attached ❑ Schedule E - Income - Gifts - Travel Payments - schedule attached 5. Verification MAILING ADDRESS STREET (Business or Agency Address Recommended - Public Document) 78495 CALLE TAMPICO CITY LA QUINTA STATE ZIP CODE CA 92253 DAYTIME TELEPHONE NUMBER ( 760 ) 777-7030 E-MAIL ADDRESS I have used all reasonable diligence in preparing this statement I have reviewed this statement and to the best of my knowledge the information contained herein and in any attached schedules is true and complete. I acknowledge this is a public document. I certify under penalty of perjury under the laws of the State of Califomia that the foregoin. ' true and_co • Date Signed 03/31/2016 (month, day, year) Signature 'ginally s atement with your filing official.) FPPC Form 700 (2015/2016) FPPC Advice Email: advice@fppc.ca.gov FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov SCHEDULE A-2 Investments, Income, and Assets of Business Entities/Trusts (Ownership Interest is 10% or Greater) ► 1. BUSINESS ENTITY OR TRUST EMERALD PRESIDIO, INC. Name PO BOX 671 LA QUINTA, CA 92247 Address (Business Address Acceptable) Check one ❑ Trust, go to 2 121 Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF THIS BUSINESS FOOD SERVICE FAIR MARKET VALUE IF APPLICABLE, LIST DATE: • $0 - $1,999 In $2,000 - $10,000 -1 / 15 15 _/____/ I. 010,001- $100,000 ACQUIRED DISPOSED Ir $100,001 - $1,000,000 • Over $1,000,000 NATURE OF INVESTMENT S CORP • Partnership • Sole Proprietorship N Other YOUR BUSINESS POSITION V.P. 2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA SHARE OF THE GROSS INCOME TO THE ENTITY/TRUST) ► 2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA SHARE OF THE GROSS INCOME TO THE ENTITY/TRUST) • $0 - $499 Ir 010,001 - 0100,000 • $500 - $1,000 • OVER $100,000 • $1,001 - $10,000 ► 3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF INCOME OF $10,000 OR MORE (Attach a separate sheet if necessary.) • None or Ir Names listed below THE PALMS GOLF CLUB SELAN 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR LEASED BY THE BUSINESS ENTITY OR TRUST ► 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR LEASED BY THE BUSINESS ENTITY OR TRUST Check one box: • INVESTMENT n REAL PROPERTY DESERT CITIES CATERING Name of Business Entity, if Investment, or Assessor's Parcel Number or Street Address of Real Property 57000 PALMS DRIVE, LA QUINTA, CA Description of Business Activity or City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE: • $2,000 - $10,000 Ir $10,001 - $100,000 / 15 / / 15 __/ • 0100,001 - $1,000,000 ACQUIRED DISPOSED • Over $1,000,000 NATURE OF INTEREST • Property Ownership/Deed of Trust • Stock • Partnership (% Leasehold 1 • Other Yrs. remaining El Check box if additional schedules reporting investments or real property are attached CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION Name JOHN PENA 1. BUSINESS ENTITY OR TRUST JOHN PENA & ASSOCIATES Name Address (Business Address Acceptable) Check one 0 Trust, go to 2 7 Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF THIS BUSINESS CONSULTING FAIR MARKET VALUE IF APPLICABLE, LIST DATE: • $0 - $1,999 • $2,000 - $10,000 / / 15 - _/_/ 15 Ir 010,001 - $100,000 ACQUIRED DISPOSED • $100,001 - $1,000,000 • Over $1,000,000 NATURE OF INVESTMENT • Partnership Ir Sole Proprietorship • Other YOUR BUSINESS POSITION PRINCIPAL 2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA SHARE OF THE GROSS INCOME TO THE ENTITY/TRUST) • $0 - $499 (r $10,001 - $100,000 • $500 - $1,000 • OVER $100,000 • $1,001 - $10,000 3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF INCOME OF $10,000 OR MORE (Attach a separate sheet if necessary.) • None or IJ Names•listed below DHS FACILITIES LLC ENGLANDER, KNABE, ALLEN & ASSOCIATES LAW FIRM SELAN 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR LEASED BY THE BUSINESS ENTITY OR TRUST Check one box: • INVESTMENT • REAL PROPERTY Name of Business Entity, if Investment, or Assessor's Parcel Number or Street Address of Real Property Description of Business Activity or City or Other Precise Location of Real Property , FAIR MARKET VALUE IF APPLICABLE, LIST DATE: • 02,000 - 010,000 . • 010,001 - 0100,000 • / / 15 . / / 15 • $100,001 - $1,000,000 ACQUIRED DISPOSED • Over $1,000,000 NATURE OF INTEREST • Property Ownership/Deed of Trust • Stock • Partnership • Leasehold • Other Yrs. remaining • Check box if additional schedules reporting investments or real property are attached Comments. FPPC Form 700 (2015/2016) Sch. A-2 FPPC Advice Email: advice@fppc.ca.gov FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov SCHEDULE B Interests in Real Property (Including Rental Income) ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS 51910 AVENIDA NAVARRO CITY LA QUINTA, CA FAIR MARKET VALUE IF APPLICABLE, LIST DATE: • $2,000 - $10,000 • $10,001 - $100,000 / / 15 j_/ 15 n$100,001 - $1,000,000 ACQUIRED DISPOSED • Over $1,000,000 NATURE OF INTEREST r] Ownership/Deed of Trust • Easement • Ownership/Deed of Trust • Easement • Leasehold II Yrs. remaining Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED • $0 - $499 • $500 - $1,000 n $1,001.- $10,000 • $0 - $499 • $500 - $1,000 • • $1,001 - $10,000 • $10,001 - $100,000 • OVER $100,000 SOURCES OF RENTAL INCOME: If you own a 10% or greater interest, list the name of each tenant that is a single source of income of $10,000 or more. • None • None CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION Name JOHN PENA P. ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS CITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: • $2,000 - $10,000 • $10,001 $100,000 / / 15 15 - _ __J_/ • $100,001 - $1,000,000 ACQUIRED DISPOSED • Over $1,000,000 NATURE OF INTEREST • Ownership/Deed of Trust • Easement • Leasehold Yrs. remaining Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED • $0 - $499 • $500 - $1,000 • • $1,001 - $10,000 • $10,001 - $100,000 • OVER $100,000 SOURCES OF RENTAL INCOME: If you own a 10% or greater interest, list the name of each tenant that is a single source of income of $10,000 or more. • None * You are not required to report loans from commercial lending institutions made in the lender's regular course of business on terms available to members of the public without regard to your official status. Personal loans and loans received not in a lender's regular course of business must be disclosed as follows: NAME OF LENDER* ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENDER INTEREST RATE TERM (Months/Years) ❑ None HIGHEST BALANCE DURING REPORTING PERIOD $500 - $1,000 111 $1,001 - $10,000 $10,001 - $100,000 111 OVER $100,000 Guarantor, if applicable NAME OF LENDER* ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENDER INTEREST RATE TERM (Months/Years) Ok None HIGHEST BALANCE DURING REPORTING PERIOD $500 - 51,000 .0 510,001 - 5100,000 ❑ Guarantor, if applicable 51,001 - 510,000 OVER 5100,000 Comments' FPPC Form 700 (2015/2016) Sch. B FPPC Advice Email: advice@fppc.ca.gov FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) ► 1. INCOME RECEIVED NAME OF SOURCE OF INCOME MARKETSTAR CORP ADDRESS (Business Address Acceptable) 2475 WASHINGTON BLVD, OGDEN, UT BUSINESS ACTIVITY, IF ANY, OF SOURCE COMMUNICATIONS YOUR BUSINESS POSITION TERRITORY MANAGER GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 z $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED Salary ❑ Spouse's or registered domestic partner's income (For self-employed use Schedule A-2.) ❑ Partnership (Less than 10% ownership. For 10% or greater use Schedule A-2.) ❑ Sale of (Real property, car, boat, etc.) ❑ Loan repayment ❑ Commission or ❑ Rental Income, list each source of $10,000 or more (Describe) ► 1. INCOME RECEIVED CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION Name JOHN PENA NAME OF SOURCE OF INCOME R J CARREON MD FOUNDATION ADDRESS (Business Address Acceptable) 40101 MONTEREY AVE. STE. B1, #215 RM, 92270 BUSINESS ACTIVITY, IF ANY, OF SOURCE CHARITABLE FOUNDATION YOUR BUSINESS POSITION INTERIM EXECUTIVE DIRECTOR GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $10,001 - $100,000 ® $1,001 - $10,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED © Salary ❑ Spouse's or registered domestic partner's income (For self-employed use Schedule A-2.) ❑ Partnership (Less than 10% ownership. For 10% or greater use Schedule A-2.) ❑ Sale of (Real property, car, boat, etc.) ❑ Loan repayment ❑ Commission or ❑ Rental Income, list each source of $10,000 or more (Describe) ❑ Other ❑ Other (Describe) (Describe) ► 2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD * You are not required to report loans from commercial lending institutions, or any indebtedness created as part of a retail installment or credit card transaction, made in the lender's regular course of business on terms available to members of the public without regard to your official status. Personal loans and loans received not in a lender's regular course of business must be disclosed as follows: NAME OF LENDER* ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENDER HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 INTEREST RATE % ❑ None SECURITY FOR LOAN ❑ None ❑ Personal residence TERM (Months/Years) ❑ Real Property Street address City ❑ Guarantor ❑ Other (Describe) Comments" FPPC Form 700 (2015/2016) Sch. C FPPC Advice Email: advice@fppc.ca.gov FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) ► 1. INCOME RECEIVED NAME OF SOURCE OF INCOME TERRY ROSS ENTERPRISES ADDRESS (Business Address Acceptable) 108 VIA. CANDELARIA, COTO DE CAZA, CA BUSINESS ACTIVITY, IF ANY, OF SOURCE MARKETING YOUR BUSINESS POSITION CONSULTANT GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $10,001 - $100,000 © $1,001 - $10,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑ Spouse's or registered domestic partner's income (For self-employed use Schedule A-2.) ❑ Partnership (Less than 10% ownership. For 10% or greater use Schedule A-2.) ❑ Sale of (Real property, car, boat, etc.) ❑ Loan repayment ❑ Commission or ❑ Rental Income, list each source of $10,000 or more (Describe) ® Other CONSULTING (Describe) ► 1. INCOME RECEIVED CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION Name JOHN PENA NAME OF SOURCE OF INCOME DESERT CITIES CATERING ADDRESS (Business Address Acceptable) PO BOX 671 LA QUINTA, CA BUSINESS ACTIVITY, IF ANY, OF SOURCE CATERING/FOOD SERVICE YOUR BUSINESS POSITION GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $ too i - $i0,000 $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary © Spouse's or registered domestic partner's income (For self-employed use Schedule A-2.) ❑ Partnership (Less than 10% ownership. For 10% or greater use Schedule A-2.) ❑ Sale of (Real property, car, boat, etc.) ❑ Loan repayment ❑ Commission or ❑ Rental Income, list each source of $10,000 or more (Describe) ❑ Other (Describe) ► 2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD * You are not required to report loans from commercial lending institutions, or any indebtedness created as part of a retail installment or credit card transaction, made in the lender's regular course of business on terms available to members of the public without regard to your official status. Personal loans and loans received not in a lender's regular course of business must be disclosed as follows: NAME OF LENDER' ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENDER HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 INTEREST RATE % ❑ None SECURITY FOR LOAN ❑ None • ❑ Personal residence TERM (Months/Years) ❑ Real Property Street address City ❑ Guarantor ❑ Other (Describe) Comments' FPPC Form 700 (2015/2016) Sch. C FPPC Advice Email: advice@fppc.ca.gov FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov SCHEDULE D Income — Gifts ► NAME OF SOURCE (Not an Acronym) GOLDENVOICE ADDRESS (Business Address Acceptable) INDIO, CA BUSINESS ACTIVITY, IF ANY, OF SOURCE FESTIVAL PRODUCERS DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) 04/ 18 / 15 $ 375.00 ONE DAY PASS $ —J_/ $ —/_/_ 1. NAME OF SOURCE (Not an Acronym) ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) $ _l—/— $ _1_1 $ _l_____1 ► NAME OF SOURCE (Not an Acronym) ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) $ _/_/ $ ______/_/— _i_i$ CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION Name JOHN PENA D. NAME OF SOURCE (Not an Acronym) ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) $ —/—/ $ _/_/ $ _/_/ I. NAME OF SOURCE (Not an Acronym) ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) $ _/_/ $ ___/—/ Li $ ► NAME OF SOURCE (Not an Acronym) ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) $ _/_/ $ —/— _/_/ $ Comments' FPPC Form 700 (2015/2016) Sch. D FPPC Advice Email: advice@fppc.ca.gov FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov