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460 Pena 2021 from 07/01 to 12/31Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from 7/1/2021 through 12/31/2021 1. Type of Recipient Committee: All Committees —Complete Parts 1, 2, 3, and 4. m Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure V State Candidate Election Committee Committee Q Recall O Controlled (Also Complete Parts) o Sponsored (Also Compkfe Par(B) ❑ Purpose Committee gneral. Sponsored ❑ Primarily Formed Candidate/ Small Contributor Committee Officeholder Committee O Political Party/Central Committee (Also Complete Par( 7) 3. Committee Information NAME IF NO I.D. NUMBER COMMITTEE TO ELECT JOHN PENA CITY COUNCIL 2018 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE LA QUINTA CA 92253 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREACODE/PHONE OPTIONAL: FAX J E-MAIL ADDRESS COVER PAGE RECEIVED FIFor r l Date of election if applicable JAN 2 8 262 of 24 (Month, Day, Year) fficial Use Only CITY OF LA QUINT TY CLERK DEPARTM T 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement m Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAM E O F TR EASU RE R SHERRY LOVE-PENA MAILING ADDRESS CITY STATE ZIP CODE AREACODEIPHONE LA QUINTA CA 92253 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREACODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS 4. Verification 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 perjury under the laws of the State of California that the foregoing is tr06 and co l : ZO L 2- Executed on ; By Executed, By Dozl gnaSure p r ca dTardktate, Slsla Measure roponent or espvnsr O cat o ponsnr Executed on By pa(s Signalura nr Control) np Officeholder. Candidate. Slain Measure Proporpont Executed on By Date Signature or convomng uniceholaer, candidate, Slain Measure Proponent FPPC Form 496 (Feb/2019) 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 PENA OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IFAPPLICABLE) CITY COUNCIL CITY OF LA QUINTA RESIDENTIAL/BUSINESS ADDRESS (NO, AND STREET) CITY STATE ZIP LA QUINTP 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 AREACODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE COVER PAGE - PART 2 Page 2 of 4 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 Listnames of ofcehoider(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 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 Amounts may be rounded SUMMARY PAGE Summary Page to whole dollars. Statement covers period I g from 7/1/2021 . - M 12/31/2021 Page 3 of 4 SEE INSTRUCTIONS ON REVERSE through NAME OF FILER I.D. NUMBER COMMITTEE TO ELECT JOHN PENA CITY COUNCIL 2018 1370057 Contributions Received Column A TOTAL THIS PERIOD Column B CALENDARYEAR Calendar Year Summary for Candidates (FROM ATTACHED SCHEDULES) TOTAL TO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions.................................................. Schedule A, Line 3 $ 0 $ 19133 1/1 through 6130 7/1 to Date 2. Loans Received................................................................ Schedule a, Line 3 350 1100 350 20233 20, Contributions 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 2 $ $ Received $ $ 4. Nonmonetary Contributions ............. ....... .... ....:::::....:... Schedule C, Line 3 0 6290 21. Expenditures 350 26523 Made $ $ 5. TOTAL CONTRIBUTIONS RECEIVED...............................Add Lines 3+4 $ $ Expenditures Made 6. Payments Made................................................................ Schedule e, Line 4 $ 0 7. Loans Made....................................................................... Schedule H, Line 3 0 8. SUBTOTAL CASH PAYMENTS ....................................... Add Lines 6+7 $ 0 9. Accrued Expenses (Unpaid Bills Schedule F, Line 3 0 10. Nonmonetary Adjustment......................................................... Schedule C, Line 3 0 11. TOTAL EXPENDITURES MADE ...................................Add Lines 8+9+10 $ 0 Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 3 13. Cash Receipts ... Column A, Line 3 above 350 14. Miscellaneous Increases to Cash.. .................. ..... Schedule I, Line 4 0 15. Cash Payments ................................... ............ Column A, Line 8 above 0 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ 350 If this is a termination statement Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedules, Part $ 0 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $ 1100 $ 12073 0 $ 12073 0 0 $ 12073 To calculate Column B, add amounts in Column A to the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subject 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 496(Feb/2019) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov e.,..,fs . .. tie AnA SCHEDULE B - PART 1 Schedule B — Part 1 to whole dollars. Statement covers period Loans Received 7/1/2021 . • . t frog, IPageof through 12/31/2021 4 4 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I D. NUMBER COMMITTEE TO ELECT JOHN PENA CITY COUNCIL 2018 1370057 FULL NAME, STREETADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER Ia) OUTSTANDING ID) AMOUNT 10 AMOUNT PAID (aj OUTSTANDING IB) INTEREST IT) ORIGINAL q CUMULATIVE OF LENDER OCCUPATION AND EMPLOYER BALANCE RECEIVED THIS OR FORGIVEN BALANCE AT PAID THIS AMOUNT OF CONTRIBUTIONS (IF COMMITTEE, ALSO ENTER I D. NUMBER) (IF SELF-EMPLOYED, ENTER BEGINNING THISE PERIOD THIS PERIOD. OF HIS CLOPER PERIOD LOAN TO DATE NAME OF BUSINESS) PERIOD OD 1 I PAID UAL N A A JOHN PENA JOHN PENA & ASSOC 1100 0 % g 1100 g $ RATE � LA QUINTA, CA 92253 ❑ FORGIVEN PIER ELECT10hr 750 g 350 12/2022 g g 1100 t® IND ❑ COM ❑ OTH ❑ PTY ❑ SCC g g DATE INCURRED DATE DUE ❑ PAID CALENDAR YEAR RATE ❑ FORGIVEN PER ELECTION- t ❑ IND ❑ COM ❑ OTH ❑PTY ❑SCC $ g g g DATE INCURRED g DATE DUE ❑ PAID CALENDAR YEAR $ $ % $ S ❑ FORGIVEN PER ELECTION` RATE $ $ $ $ S t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED SUBTOTALS $ 350 $ 0 $ 1100 $ 0 Schedule B Summary 1. Loans received this period....................................................................................................................$ (Total Column (b) plus unitemized loans of less than $100.) 2. Loans paid or forgiven this period.........................................................................................................$ (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 $ Enter the net here and on the Summary Page, Column A, Line 2. 'Amounts forgiven or paid by another party also must be reported on Schedule A. If required. 350 350 (May be a negative number) (Ens er (e) on 5&,ed ule 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 FPPC Form 496 (Feb/2019) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov