Recipient Committee Campaign Statement Cover Page
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COVER PAGE Recipient Committee Type or print in ink. Date Stamp Campaign Statement CALIFORNIA 460 Cover Page FORM (Government Code Sections 84200-84216.5) Statement covers period Date of election if applicable: 1 274 (Month, Day, Year) Page of 03/18/2014 from For Official Use Only 06/03/2014 SEE INSTRUCTIONS ON REVERSE through 05/17/2014 1. Type of Recipient Committee: All Committees – Complete Parts 1, 2, 3, and 4. 2. Type of Statement: X Officeholder, Candidate Controlled Committee Primarily Formed Ballot Measure X Preelection Statement Quarterly Statement State Candidate Election Committee Committee Semi-annual Statement Special Odd-Year Report Recall Controlled Termination Statement Supplemental Preelection (Also Complete Part 5) Sponsored (Also file a Form 410 Termination) Statement - Attach Form 495 (Also Complete Part 6) General Purpose Committee Amendment (Explain below) Sponsored Primarily Formed Candidate/ Small Contributor Committee Officeholder Committee Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER Treasurer(s) 1362752 COMMITTEE NAME (OR CANDIDATE’S NAME IF NO COMMITTEE) NAME OF TREASURER BOBBY SHRIVER FOR SUPERVISOR 2014 DAVID L. GOULD MAILING ADDRESS 3700 WILSHIRE BLVD STE 1050B STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 3700 WILSHIRE BLVD STE 1050B LOS ANGELES CA 90010 (213)489-4792 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY LOS ANGELES CA 90010 (213)489-4792 INGRID ORELLANA MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX MAILING ADDRESS 3700 WILSHIRE BLVD STE 1050B CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE LOS ANGELES CA 90010 (213)489-4792 OPTIONAL: FAX / E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS (213)489-4818 / [email protected] 4. Verification 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 perjury under the laws of the State of California that the foregoing is true and correct. Executed on 05/22/2014 By Date Signature of Treasurer or Assistant Treasurer Executed on 05/22/2014 By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Officer of Sponsor Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) State of California www.netfile.com Type or print in ink. COVER PAGE - PART 2 Recipient Committee CALIFORNIA Campaign Statement FORM 460 Cover Page — Part 2 Page 2 of 274 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE BOBBY SHRIVER OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO. OR LETTER JURISDICTION SUPPORT County Supervisor: LOS ANGELES District 3 OPPOSE RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP Identify the controlling officeholder, candidate, or state measure proponent, if any. 3700 WILSHIRE BLVD STE 1050B LOS ANGELES CA 90010 NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT 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 OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER 7. Primarily Formed Candidate/Officeholder Committee List names of CONTROLLED COMMITTEE? NAME OF TREASURER officeholder(s) or candidate(s) for which this committee is primarily formed. YES NO NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) SUPPORT OPPOSE CITY STATE ZIP CODE AREA CODE/PHONE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD SUPPORT OPPOSE COMMITTEE NAME I.D. NUMBER NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD SUPPORT OPPOSE CONTROLLED COMMITTEE? NAME OF TREASURER NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD SUPPORT YES NO OPPOSE COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) State of California www.netfile.com Campaign Disclosure Statement Type or print in ink. SUMMARY PAGE Amounts may be rounded Statement covers period Summary Page to whole dollars. CALIFORNIA from 03/18/2014 FORM 460 05/17/2014 Page 3 of 274 SEE INSTRUCTIONS ON REVERSE through NAME OF FILER I.D. NUMBER BOBBY SHRIVER FOR SUPERVISOR 2014 1362752 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTAL THIS PERIOD CALENDAR YEAR (FROM ATTACHED SCHEDULES) TOTAL TO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions ........................................... Schedule A, Line 3 $ 1,028,954.00 $ 1,876,095.00 1/1 through 6/30 7/1 to Date 2. Loans Received ...................................................... Schedule B, Line 3 0.00 0.00 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 + 2 $ 1,028,954.00 $ 1,876,095.00 Received $ $ 3,600.00 4,200.00 4. Nonmonetary Contributions .................................... Schedule C, Line 3 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 + 4 $ 1,032,554.00 $ 1,880,295.00 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made ....................................................... Schedule E, Line 4 $ 1,128,866.19 $ 1,336,294.78 Candidates 7. Loans Made ............................................................. Schedule H, Line 3 0.00 0.00 22. Cumulative Expenditures Made* 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 $ 1,128,866.19 $ 1,336,294.78 (If Subject to Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F, Line 3 6,500.00 6,500.00 Date of Election Total to Date (mm/dd/yy) 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 3,600.00 4,200.00 11. TOTAL EXPENDITURES MADE ................................Add Lines 8 + 9 + 10 $ 1,138,966.19 $ 1,346,994.78 / / $ Current Cash Statement / / $ 639,712.41 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ To calculate Column B, add 13. Cash Receipts ................................................... Column A, Line 3 above 1,028,954.00 amounts in Column A to the corresponding amounts 0.00 *Amounts in this section may be different from amounts 14. Miscellaneous Increases to Cash ........................... Schedule I, Line 4 from Column B of your last reported in Column B. report. Some amounts in 15. Cash Payments .................................................. Column A, Line 8 above 1,128,866.19 Column A may be negative 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 539,800.22 figures that should be subtracted from previous If this is a termination statement, Line 16 must be zero. period amounts. If this is the first report being filed for this calendar year, only 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ 0.00 carry over the amounts from Lines 2, 7, and 9 (if Cash Equivalents and Outstanding Debts any). 18. Cash Equivalents ........................................ See instructions on reverse $ 0.00 19. Outstanding Debts ......................... Add Line 2 + Line 9 in Column B above $ 6,500.00 FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) www.netfile.com Schedule A Type or print in ink. SCHEDULE A Amounts may be rounded Statement covers period Monetary Contributions Received to whole dollars. CALIFORNIA from 03/18/2014 FORM 460 through 05/17/2014 Page 4 of 274 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER BOBBY SHRIVER FOR SUPERVISOR 2014 1362752 IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) 03/18/2014 Richard Cuesta X IND Retired -300.00 0.00 3014 Exposition Blvd. None Santa Monica, CA 90404 COM NGP ERROR OTH PTY SCC 03/18/2014 Charlotte Dowley X IND Student 300.00 300.00 17 State St n/a New York, NY 10004-1501 COM OTH PTY SCC 03/18/2014 Endurance Painting IND 300.00 300.00 15414 Cabrito Rd Van Nuys, CA 91406-1439 COM X OTH PTY SCC 03/18/2014 Evan Hainey X IND Manager 300.00 300.00 16030 Ventura Blvd Untitled Entertainment Encino, CA 91436-4487 COM OTH PTY SCC 03/18/2014 Daniel Kirschner X IND Senior Vice President - 300.00 300.00 517 7th St Corporate Affairs Santa Monica, CA 90402-2707 COM Activision Blizzard OTH PTY SCC SUBTOTAL $ 900.00 Schedule A Summary *Contributor Codes 1. Amount received this period – itemized monetary contributions. IND – Individual 1,027,006.00 COM – Recipient Committee (Include all Schedule A subtotals.) ........................................................................................................ $ (other than PTY or SCC) 1,948.00 OTH – Other (e.g.,