california form 700 statement of economic interests · the period covered is january 1, 2016,...
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LeavingOffice: Date Left / / (Check one)
The period covered is January 1, 2016, through the date of leaving office.
The period covered is / / , through the date of leaving office.
Annual: The period covered is January 1, 2016, through December 31, 2016.
The period covered is / / , through December 31, 2016.
StAtementOfeCOnOmiC intereStS
COverPAge
FPPC Form 700 (2016/2017)FPPC Advice Email: [email protected]
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
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.
icertifyunderpenaltyofperjuryunder the lawsof theStateofCalifornia that the foregoing is trueandcorrect.
DateSigned (month, day, year)
3. typeofStatement (Check at least one box)
State Judge or Court Commissioner (Statewide Jurisdiction)
Multi-County County of
City of Other
2. JurisdictionofOffice (Check at least one box)
Candidate: Election year and office sought, if different than Part 1:
AssumingOffice: Date assumed / /
Date InitialFilingReceivedOfficial Use Only
Please type or print in ink.
700FAIr POLITICAL PrACTICES COMMISSION
CALIFORNIA FORM
Agency Name (Do not use acronyms)
Division, board, Department, District, if applicable Your Position
1.Office,Agency,orCourt
nAmeOffiLer (LASt) (firSt) (miDDLe)
MAiLiNg ADDrESS STrEET CiTY STATE ZiP CODE
( )DAYTiME TELEPhONE NuMbEr E-MAiL ADDrESS
(Business or Agency Address Recommended - Public Document)
Signature (File the originally signed statement with your filing official.)
5.verification
A PuBLIC DOCuMENT
► If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency: Position:
-or-
-or-
None - No reportable interests on any schedule
4. ScheduleSummary(mustcomplete)Schedules attached
ScheduleA-1 - Investments – schedule attached ScheduleA-2 - Investments – schedule attached ScheduleB- Real Property – schedule attached
► Total number of pages including this cover page:
-or-
ScheduleC- Income, Loans, & Business Positions – schedule attached ScheduleD- Income – Gifts – schedule attached Schedulee - Income – Gifts – Travel Payments – schedule attached
Miller Rogen Lauren
California Institute of Regenerative Medicine
ICOC Board Member
✘
11
✘
✘
✘
✘
9301 Wilshire Blvd Ste 507 Beverly Hills CA 90210-6150
310 271-9444 [email protected]
02/23/2017 09:41 AM
✘
Filed Date: 02/23/2017 09:41 AMSAN: FPPC
Electronic Submission
IFAPPLICABLE,LISTDATE:
/ / / / ACQuIRED DISPOSED
IFAPPLICABLE,LISTDATE:
/ / / / ACQuIRED DISPOSED
IFAPPLICABLE,LISTDATE:
/ / / / ACQuIRED DISPOSED
IFAPPLICABLE,LISTDATE:
/ / / / ACQuIRED DISPOSED
IFAPPLICABLE,LISTDATE:
/ / / / ACQuIRED DISPOSED
IFAPPLICABLE,LISTDATE:
/ / / / ACQuIRED DISPOSED
16 16 16 16
1616
161616
Name
►NAMEOFBuSINESSENTITY
GENERALDESCRIPTIONOFTHISBuSINESS
►NAMEOFBuSINESSENTITY
GENERALDESCRIPTIONOFTHISBuSINESS
►NAMEOFBuSINESSENTITY
GENERALDESCRIPTIONOFTHISBuSINESS
►NAMEOFBuSINESSENTITY
GENERALDESCRIPTIONOFTHISBuSINESS
►NAMEOFBuSINESSENTITY
GENERALDESCRIPTIONOFTHISBuSINESS
►NAMEOFBuSINESSENTITY
GENERALDESCRIPTIONOFTHISBuSINESS
Comments:
SChEDuLE A-1Investments
Stocks,Bonds,andOther Interests(Ownership Interest isLessThan10%)
Do not attach brokerage or financial statements.
700FAIr POLITICAL PrACTICES COMMISSION
CALIFORNIA FORM
FPPC Form 700 (2016/2017) Sch. A-1FPPC Advice Email: [email protected]
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
FAIRMARKETvALuE $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
FAIRMARKETvALuE $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
FAIRMARKETvALuE $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
FAIRMARKETvALuE $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
FAIRMARKETvALuE $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
FAIRMARKETvALuE $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
16
NATuREOF INvESTMENT Stock Other
(Describe) Partnership IncomeReceived of $0 - $499
IncomeReceivedof$500orMore (Report on Schedule C)
NATuREOF INvESTMENT Stock Other
(Describe) Partnership IncomeReceivedof$0 -$499
IncomeReceivedof$500orMore (Report on Schedule C)
NATuREOF INvESTMENT Stock Other
(Describe) Partnership IncomeReceivedof$0 -$499
IncomeReceivedof$500orMore (Report on Schedule C)
NATuREOF INvESTMENT Stock Other
(Describe) Partnership IncomeReceived of $0 - $499
IncomeReceivedof$500orMore (Report on Schedule C)
NATuREOF INvESTMENT Stock Other
(Describe) Partnership IncomeReceived of $0 - $499
IncomeReceivedof$500orMore (Report on Schedule C)
NATuREOF INvESTMENT Stock Other
(Describe) Partnership IncomeReceivedof$0 -$499
IncomeReceivedof$500orMore (Report on Schedule C)
1616
Lauren Miller Rogen
Plains All American Pipeline
Oil & Gas
✘
✘✘
16 16
Chateau Belmont Shores, LP
Rental property
✘
✘✘
16 16
Universe at Sea Breeze LP
Rental Property
✘
✘✘
16 16
16 16
16 16
16 16
►3. LIST ThE NAME OF EACh rEPOrTABLE SINGLE SOurCE OF INCOME OF $10,000 Or MOrE (Attach a separate sheet if necessary.)
IFAPPLICABLE,LISTDATE:
/ / / / ACQuIRED DISPOSED
IFAPPLICABLE,LISTDATE:
/ / / / ACQuIRED DISPOSED
IFAPPLICABLE,LISTDATE:
/ / / / ACQuIRED DISPOSED
IFAPPLICABLE,LISTDATE:
/ / / / ACQuIRED DISPOSED
16 16
16 1616 16
SChEDuLE A-2Investments, Income, and Assets
of Business Entities/Trusts(Ownership Interest is10%orGreater)
Comments:
Name
Address (Business Address Acceptable)
Name
Address (Business Address Acceptable)
FAIRMARKETvALuE $0 - $1,999 $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
FAIRMARKETvALuE $0 - $1,999 $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
GENERALDESCRIPTIONOFTHISBuSINESS
GENERALDESCRIPTIONOFTHISBuSINESS
INvESTMENT REAL PROPERTY
NameofBusinessEntity, if Investment,or Assessor’sParcelNumberorStreetAddressofRealProperty
Description of Business Activity orCity or Other Precise Location of Real Property
INvESTMENT REAL PROPERTY
NameofBusinessEntity, if Investment,or Assessor’sParcelNumberorStreetAddressofRealProperty
Description of Business Activity orCity or Other Precise Location of Real Property
►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 Trust, go to 2 Business Entity, complete the box, then go to 2
Check one Trust, go to 2 Business Entity, complete the box, then go to 2
►3. LIST ThE NAME OF EACh rEPOrTABLE SINGLE SOurCE OF INCOME OF $10,000 Or MOrE (Attach a separate sheet if necessary.)
►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)
Name
700
Check one box: Check one box:
YOuRBuSINESSPOSITION YOuRBuSINESSPOSITION
FPPC Form 700 (2016/2017) Sch. A-2FPPC Advice Email: [email protected]
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
FAIRMARKETvALuE $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
FAIRMARKETvALuE $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
$0 - $499
$500 - $1,000
$1,001 - $10,000
$0 - $499
$500 - $1,000
$1,001 - $10,000
$10,001 - $100,000 OvER$100,000
$10,001 - $100,000 OvER$100,000
FAIr POLITICAL PrACTICES COMMISSION
CALIFORNIA FORM
►1. BuSINESS ENTITY Or TruST ►1. BuSINESS ENTITY Or TruST
NATuREOF INTEREST PropertyOwnership/DeedofTrust Stock Partnership
Leasehold Other
Check box if additional schedules reporting investments or real property are attached
Yrs. remaining
NATuREOF INTEREST PropertyOwnership/DeedofTrust Stock Partnership
Leasehold Other
Check box if additional schedules reporting investments or real property are attached
Yrs. remaining
16 16
Other
NATuREOF INvESTMENT Partnership Sole Proprietorship
Other
NATuREOF INvESTMENT Partnership Sole Proprietorship
None Noneor or Names listed below Names listed below
Lauren Miller Rogen
Don't Rain on My Parade, Inc.
9301 Wilshire Blvd. Ste 507, Beverly Hills, CA 90210
✘
Writing & Acting Services
✘
16 16
✘Corporation
President
✘
✘
Sony Pictures Television, Inc.
16 16
Point Grey Pictures, Inc.
9301 Wilshire Blvd. Ste 507, Beverly Hills, CA 90210
✘
Film & TV Production
✘
16 16
✘Corporation
owned by husband
✘
✘
Good Universe, NBC Universal, Mesquite Productions,Inc., Columbia Pictures Industries, Inc., Disaster ArtistLLC
16 16
►3. LIST ThE NAME OF EACh rEPOrTABLE SINGLE SOurCE OF INCOME OF $10,000 Or MOrE (Attach a separate sheet if necessary.)
IFAPPLICABLE,LISTDATE:
/ / / / ACQuIRED DISPOSED
IFAPPLICABLE,LISTDATE:
/ / / / ACQuIRED DISPOSED
IFAPPLICABLE,LISTDATE:
/ / / / ACQuIRED DISPOSED
IFAPPLICABLE,LISTDATE:
/ / / / ACQuIRED DISPOSED
16 16
16 1616 16
SChEDuLE A-2Investments, Income, and Assets
of Business Entities/Trusts(Ownership Interest is10%orGreater)
Comments:
Name
Address (Business Address Acceptable)
Name
Address (Business Address Acceptable)
FAIRMARKETvALuE $0 - $1,999 $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
FAIRMARKETvALuE $0 - $1,999 $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
GENERALDESCRIPTIONOFTHISBuSINESS
GENERALDESCRIPTIONOFTHISBuSINESS
INvESTMENT REAL PROPERTY
NameofBusinessEntity, if Investment,or Assessor’sParcelNumberorStreetAddressofRealProperty
Description of Business Activity orCity or Other Precise Location of Real Property
INvESTMENT REAL PROPERTY
NameofBusinessEntity, if Investment,or Assessor’sParcelNumberorStreetAddressofRealProperty
Description of Business Activity orCity or Other Precise Location of Real Property
►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 Trust, go to 2 Business Entity, complete the box, then go to 2
Check one Trust, go to 2 Business Entity, complete the box, then go to 2
►3. LIST ThE NAME OF EACh rEPOrTABLE SINGLE SOurCE OF INCOME OF $10,000 Or MOrE (Attach a separate sheet if necessary.)
►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)
Name
700
Check one box: Check one box:
YOuRBuSINESSPOSITION YOuRBuSINESSPOSITION
FPPC Form 700 (2016/2017) Sch. A-2FPPC Advice Email: [email protected]
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
FAIRMARKETvALuE $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
FAIRMARKETvALuE $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
$0 - $499
$500 - $1,000
$1,001 - $10,000
$0 - $499
$500 - $1,000
$1,001 - $10,000
$10,001 - $100,000 OvER$100,000
$10,001 - $100,000 OvER$100,000
FAIr POLITICAL PrACTICES COMMISSION
CALIFORNIA FORM
►1. BuSINESS ENTITY Or TruST ►1. BuSINESS ENTITY Or TruST
NATuREOF INTEREST PropertyOwnership/DeedofTrust Stock Partnership
Leasehold Other
Check box if additional schedules reporting investments or real property are attached
Yrs. remaining
NATuREOF INTEREST PropertyOwnership/DeedofTrust Stock Partnership
Leasehold Other
Check box if additional schedules reporting investments or real property are attached
Yrs. remaining
16 16
Other
NATuREOF INvESTMENT Partnership Sole Proprietorship
Other
NATuREOF INvESTMENT Partnership Sole Proprietorship
None Noneor or Names listed below Names listed below
Lauren Miller Rogen
Ketchup Chip, Inc.
9301 Wilshire Blvd. Ste 507, Beverly Hills, CA 90210
✘
Writing and Acting Services
✘
16 16
✘Corporation
owned by husband
✘
✘
GEP Talent Services, LLC
16 16
Three Men and a Building LLC
9301 Wilshire Blvd. Ste 507, Beverly Hills, CA 90210
✘
Real estate holding
✘ 16 16
✘
✘
✘
16 16
NAME OF LENDER*
ADDRESS (Business Address Acceptable)
BuSINESSACTIvITY, IFANY,OFLENDER
IFAPPLICABLE,LISTDATE:
/ / / / ACQuIRED DISPOSED
IFAPPLICABLE,LISTDATE:
/ / / / ACQuIRED DISPOSED
16 1616 16
SChEDuLE BInterests in real Property
(IncludingRental Income)
Name
►ASSESSOR’SPARCELNuMBERORSTREET ADDRESS
►ASSESSOR’SPARCELNuMBERORSTREET ADDRESS
CITY CITY
INTERESTRATE TERM(Months/Years)
% None
SOuRCESOFRENTAL INCOME: Ifyouowna10%orgreaterinterest, list the name of each tenant that is a single source of income of $10,000 or more.
SOuRCESOFRENTAL INCOME: Ifyouowna10%orgreaterinterest, list the name of each tenant that is a single source of income of $10,000 or more.
NATuREOF INTEREST
Ownership/DeedofTrust Easement
Leasehold Yrs. remaining Other
NATuREOF INTEREST
Ownership/DeedofTrust Easement
Leasehold Yrs. remaining Other
Comments:
FAIRMARKETvALuE $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
FAIRMARKETvALuE $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
IFRENTALPROPERTY,GROSSINCOMERECEIvED
OvER$100,000
$500 - $1,000 $0 - $499 $1,001 - $10,000
$10,001 - $100,000
IFRENTALPROPERTY,GROSSINCOMERECEIvED
OvER$100,000
$500 - $1,000 $0 - $499 $1,001 - $10,000
$10,001 - $100,000
HIGHESTBALANCEDuRINGREPORTINGPERIOD
Guarantor, if applicable
OvER$100,000
$500 - $1,000 $1,001 - $10,000
$10,001 - $100,000
FPPC Form 700 (2016/2017) Sch. BFPPC Advice Email: [email protected]
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
700FAIr POLITICAL PrACTICES COMMISSION
CALIFORNIA FORM
NAME OF LENDER*
ADDRESS (Business Address Acceptable)
BuSINESSACTIvITY, IFANY,OFLENDER
INTERESTRATE TERM(Months/Years)
% None
Guarantor, if applicable
HIGHESTBALANCEDuRINGREPORTINGPERIOD
OvER$100,000
$500 - $1,000 $1,001 - $10,000
$10,001 - $100,000
* Youarenotrequiredtoreportloansfromcommerciallendinginstitutionsmadeinthelender’sregularcourseofbusinessontermsavailabletomembersofthepublicwithoutregardtoyourofficialstatus.Personalloansandloansreceivednotinalender’sregularcourseofbusinessmustbedisclosedasfollows:
None None
Lauren Miller Rogen
Chateau Belmont Shores, 40 Bayshore Ave.
Long Beach, CA 90803
✘
16 16
✘LLC ownership
✘
✘
Sea Breeze Vacation Rentals, 3150 Ocean St.
Carlsbad, CA 92008
✘
16 16
✘LLC ownership
✘
✘
FPPC Form 700 (2016/2017) Sch. CFPPC Advice Email: [email protected]
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
(Real property, car, boat, etc.) (Real property, car, boat, etc.)
SChEDuLE CIncome, Loans, & Business
Positions(Other than Gifts and Travel Payments)
GROSSINCOMERECEIvED No Income - Business Position Only No Income - Business Position OnlyGROSSINCOMERECEIvED
Name
OvER$100,000 OvER$100,000 $500 - $1,000 $500 - $1,000 $1,001 - $10,000 $1,001 - $10,000
$10,001 - $100,000 $10,001 - $100,000
700FAIr POLITICAL PrACTICES COMMISSION
CALIFORNIA FORM
► 1. INCOME rECEIVED NAMEOFSOuRCEOF INCOME
ADDRESS (Business Address Acceptable)
BuSINESSACTIvITY, IFANY,OFSOuRCE
YOuRBuSINESSPOSITION
► 1. INCOME rECEIVED NAMEOFSOuRCEOF INCOME
ADDRESS (Business Address Acceptable)
BuSINESSACTIvITY, IFANY,OFSOuRCE
YOuRBuSINESSPOSITION
NAME OF LENDER*
ADDRESS (Business Address Acceptable)
BuSINESSACTIvITY, IFANY,OFLENDER
INTERESTRATE TERM(Months/Years)
% None
HIGHESTBALANCEDuRINGREPORTINGPERIOD
$500 - $1,000
$1,001 - $10,000
$10,001 - $100,000
OvER$100,000
Comments:
► 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 retailinstallmentorcreditcardtransaction,madeinthelender’sregularcourseofbusinessontermsavailabletomembersofthepublicwithoutregardtoyourofficialstatus.Personalloansandloansreceivednotinalender’sregular course of business must be disclosed as follows:
SECuRITYFORLOAN
None Personal residence
Real Property
Guarantor
Other
Street address
City
(Describe)
CONSIDERATIONFORWHICHINCOMEWASRECEIvED Salary Spouse’sor registereddomesticpartner’s income
(For self-employed use Schedule A-2.)
Partnership (Less than 10% ownership. For 10% or greater use Schedule A-2.)
Sale of
Other
CONSIDERATIONFORWHICHINCOMEWASRECEIvED Salary Spouse’sor registereddomesticpartner’s income
(For self-employed use Schedule A-2.)
Partnership (Less than 10% ownership. For 10% or greater use Schedule A-2.)
Sale of
Other
(Describe) (Describe)
(Describe) (Describe)
Rental Income, list each source of $10,000 or more Rental Income, list each source of $10,000 or moreCommission or Commission or
Loan repayment Loan repayment
Lauren Miller Rogen
GEP Talent Services, LLC
2835 N. Naomi St. 2nd Fl, Burbank, CA 91504
Services & Residuals
Employee
✘
✘
NBC Universal
100 Universal City Plaza, Universal City, CA 91608
Residuals
Employee
✘
✘
FPPC Form 700 (2016/2017) Sch. CFPPC Advice Email: [email protected]
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
(Real property, car, boat, etc.) (Real property, car, boat, etc.)
SChEDuLE CIncome, Loans, & Business
Positions(Other than Gifts and Travel Payments)
GROSSINCOMERECEIvED No Income - Business Position Only No Income - Business Position OnlyGROSSINCOMERECEIvED
Name
OvER$100,000 OvER$100,000 $500 - $1,000 $500 - $1,000 $1,001 - $10,000 $1,001 - $10,000
$10,001 - $100,000 $10,001 - $100,000
700FAIr POLITICAL PrACTICES COMMISSION
CALIFORNIA FORM
► 1. INCOME rECEIVED NAMEOFSOuRCEOF INCOME
ADDRESS (Business Address Acceptable)
BuSINESSACTIvITY, IFANY,OFSOuRCE
YOuRBuSINESSPOSITION
► 1. INCOME rECEIVED NAMEOFSOuRCEOF INCOME
ADDRESS (Business Address Acceptable)
BuSINESSACTIvITY, IFANY,OFSOuRCE
YOuRBuSINESSPOSITION
NAME OF LENDER*
ADDRESS (Business Address Acceptable)
BuSINESSACTIvITY, IFANY,OFLENDER
INTERESTRATE TERM(Months/Years)
% None
HIGHESTBALANCEDuRINGREPORTINGPERIOD
$500 - $1,000
$1,001 - $10,000
$10,001 - $100,000
OvER$100,000
Comments:
► 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 retailinstallmentorcreditcardtransaction,madeinthelender’sregularcourseofbusinessontermsavailabletomembersofthepublicwithoutregardtoyourofficialstatus.Personalloansandloansreceivednotinalender’sregular course of business must be disclosed as follows:
SECuRITYFORLOAN
None Personal residence
Real Property
Guarantor
Other
Street address
City
(Describe)
CONSIDERATIONFORWHICHINCOMEWASRECEIvED Salary Spouse’sor registereddomesticpartner’s income
(For self-employed use Schedule A-2.)
Partnership (Less than 10% ownership. For 10% or greater use Schedule A-2.)
Sale of
Other
CONSIDERATIONFORWHICHINCOMEWASRECEIvED Salary Spouse’sor registereddomesticpartner’s income
(For self-employed use Schedule A-2.)
Partnership (Less than 10% ownership. For 10% or greater use Schedule A-2.)
Sale of
Other
(Describe) (Describe)
(Describe) (Describe)
Rental Income, list each source of $10,000 or more Rental Income, list each source of $10,000 or moreCommission or Commission or
Loan repayment Loan repayment
Lauren Miller Rogen
Cast & Crew Talent Services
450 7th Ave. Ste 900, NY, NY 10123
Acting Services
Employee
✘
✘
SPE Corporate Services, Inc.
900 Corporate Pointe Box 3638, Culver City, CA 90231
Residuals
Employee
✘
✘
FPPC Form 700 (2016/2017) Sch. CFPPC Advice Email: [email protected]
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
(Real property, car, boat, etc.) (Real property, car, boat, etc.)
SChEDuLE CIncome, Loans, & Business
Positions(Other than Gifts and Travel Payments)
GROSSINCOMERECEIvED No Income - Business Position Only No Income - Business Position OnlyGROSSINCOMERECEIvED
Name
OvER$100,000 OvER$100,000 $500 - $1,000 $500 - $1,000 $1,001 - $10,000 $1,001 - $10,000
$10,001 - $100,000 $10,001 - $100,000
700FAIr POLITICAL PrACTICES COMMISSION
CALIFORNIA FORM
► 1. INCOME rECEIVED NAMEOFSOuRCEOF INCOME
ADDRESS (Business Address Acceptable)
BuSINESSACTIvITY, IFANY,OFSOuRCE
YOuRBuSINESSPOSITION
► 1. INCOME rECEIVED NAMEOFSOuRCEOF INCOME
ADDRESS (Business Address Acceptable)
BuSINESSACTIvITY, IFANY,OFSOuRCE
YOuRBuSINESSPOSITION
NAME OF LENDER*
ADDRESS (Business Address Acceptable)
BuSINESSACTIvITY, IFANY,OFLENDER
INTERESTRATE TERM(Months/Years)
% None
HIGHESTBALANCEDuRINGREPORTINGPERIOD
$500 - $1,000
$1,001 - $10,000
$10,001 - $100,000
OvER$100,000
Comments:
► 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 retailinstallmentorcreditcardtransaction,madeinthelender’sregularcourseofbusinessontermsavailabletomembersofthepublicwithoutregardtoyourofficialstatus.Personalloansandloansreceivednotinalender’sregular course of business must be disclosed as follows:
SECuRITYFORLOAN
None Personal residence
Real Property
Guarantor
Other
Street address
City
(Describe)
CONSIDERATIONFORWHICHINCOMEWASRECEIvED Salary Spouse’sor registereddomesticpartner’s income
(For self-employed use Schedule A-2.)
Partnership (Less than 10% ownership. For 10% or greater use Schedule A-2.)
Sale of
Other
CONSIDERATIONFORWHICHINCOMEWASRECEIvED Salary Spouse’sor registereddomesticpartner’s income
(For self-employed use Schedule A-2.)
Partnership (Less than 10% ownership. For 10% or greater use Schedule A-2.)
Sale of
Other
(Describe) (Describe)
(Describe) (Describe)
Rental Income, list each source of $10,000 or more Rental Income, list each source of $10,000 or moreCommission or Commission or
Loan repayment Loan repayment
Lauren Miller Rogen
Central Productions LLC
2600 Colorado Ave., Santa Monica, CA 90404
Services
Employee
✘
✘
Force Residuals, Inc./Media Services
500 S. Sepulveda Blvd., Los Angeles, CA 90049
Residuals
Employee
✘
✘
FPPC Form 700 (2016/2017) Sch. CFPPC Advice Email: [email protected]
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
(Real property, car, boat, etc.) (Real property, car, boat, etc.)
SChEDuLE CIncome, Loans, & Business
Positions(Other than Gifts and Travel Payments)
GROSSINCOMERECEIvED No Income - Business Position Only No Income - Business Position OnlyGROSSINCOMERECEIvED
Name
OvER$100,000 OvER$100,000 $500 - $1,000 $500 - $1,000 $1,001 - $10,000 $1,001 - $10,000
$10,001 - $100,000 $10,001 - $100,000
700FAIr POLITICAL PrACTICES COMMISSION
CALIFORNIA FORM
► 1. INCOME rECEIVED NAMEOFSOuRCEOF INCOME
ADDRESS (Business Address Acceptable)
BuSINESSACTIvITY, IFANY,OFSOuRCE
YOuRBuSINESSPOSITION
► 1. INCOME rECEIVED NAMEOFSOuRCEOF INCOME
ADDRESS (Business Address Acceptable)
BuSINESSACTIvITY, IFANY,OFSOuRCE
YOuRBuSINESSPOSITION
NAME OF LENDER*
ADDRESS (Business Address Acceptable)
BuSINESSACTIvITY, IFANY,OFLENDER
INTERESTRATE TERM(Months/Years)
% None
HIGHESTBALANCEDuRINGREPORTINGPERIOD
$500 - $1,000
$1,001 - $10,000
$10,001 - $100,000
OvER$100,000
Comments:
► 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 retailinstallmentorcreditcardtransaction,madeinthelender’sregularcourseofbusinessontermsavailabletomembersofthepublicwithoutregardtoyourofficialstatus.Personalloansandloansreceivednotinalender’sregular course of business must be disclosed as follows:
SECuRITYFORLOAN
None Personal residence
Real Property
Guarantor
Other
Street address
City
(Describe)
CONSIDERATIONFORWHICHINCOMEWASRECEIvED Salary Spouse’sor registereddomesticpartner’s income
(For self-employed use Schedule A-2.)
Partnership (Less than 10% ownership. For 10% or greater use Schedule A-2.)
Sale of
Other
CONSIDERATIONFORWHICHINCOMEWASRECEIvED Salary Spouse’sor registereddomesticpartner’s income
(For self-employed use Schedule A-2.)
Partnership (Less than 10% ownership. For 10% or greater use Schedule A-2.)
Sale of
Other
(Describe) (Describe)
(Describe) (Describe)
Rental Income, list each source of $10,000 or more Rental Income, list each source of $10,000 or moreCommission or Commission or
Loan repayment Loan repayment
Lauren Miller Rogen
Woodridge Productions, Inc.
10202 W. Washington Blvd., Culver City, CA 90232
Acting
Employee
✘
✘
Talent Partners Commercial Services LLC
111 W. Jackson Blvd. Chicago, IL 60604
Acting
Employee
✘
✘
FPPC Form 700 (2016/2017) Sch. CFPPC Advice Email: [email protected]
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
(Real property, car, boat, etc.) (Real property, car, boat, etc.)
SChEDuLE CIncome, Loans, & Business
Positions(Other than Gifts and Travel Payments)
GROSSINCOMERECEIvED No Income - Business Position Only No Income - Business Position OnlyGROSSINCOMERECEIvED
Name
OvER$100,000 OvER$100,000 $500 - $1,000 $500 - $1,000 $1,001 - $10,000 $1,001 - $10,000
$10,001 - $100,000 $10,001 - $100,000
700FAIr POLITICAL PrACTICES COMMISSION
CALIFORNIA FORM
► 1. INCOME rECEIVED NAMEOFSOuRCEOF INCOME
ADDRESS (Business Address Acceptable)
BuSINESSACTIvITY, IFANY,OFSOuRCE
YOuRBuSINESSPOSITION
► 1. INCOME rECEIVED NAMEOFSOuRCEOF INCOME
ADDRESS (Business Address Acceptable)
BuSINESSACTIvITY, IFANY,OFSOuRCE
YOuRBuSINESSPOSITION
NAME OF LENDER*
ADDRESS (Business Address Acceptable)
BuSINESSACTIvITY, IFANY,OFLENDER
INTERESTRATE TERM(Months/Years)
% None
HIGHESTBALANCEDuRINGREPORTINGPERIOD
$500 - $1,000
$1,001 - $10,000
$10,001 - $100,000
OvER$100,000
Comments:
► 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 retailinstallmentorcreditcardtransaction,madeinthelender’sregularcourseofbusinessontermsavailabletomembersofthepublicwithoutregardtoyourofficialstatus.Personalloansandloansreceivednotinalender’sregular course of business must be disclosed as follows:
SECuRITYFORLOAN
None Personal residence
Real Property
Guarantor
Other
Street address
City
(Describe)
CONSIDERATIONFORWHICHINCOMEWASRECEIvED Salary Spouse’sor registereddomesticpartner’s income
(For self-employed use Schedule A-2.)
Partnership (Less than 10% ownership. For 10% or greater use Schedule A-2.)
Sale of
Other
CONSIDERATIONFORWHICHINCOMEWASRECEIvED Salary Spouse’sor registereddomesticpartner’s income
(For self-employed use Schedule A-2.)
Partnership (Less than 10% ownership. For 10% or greater use Schedule A-2.)
Sale of
Other
(Describe) (Describe)
(Describe) (Describe)
Rental Income, list each source of $10,000 or more Rental Income, list each source of $10,000 or moreCommission or Commission or
Loan repayment Loan repayment
Lauren Miller Rogen
Plains All American Pipeline
333 Clay St. Houston, TX 77002
Oil & Gas
Partner
✘
✘
Chateau Belmont Shores, LP
40 Bayshore Ave, Long Beach, CA 90803
Real Estate Rental Property
Partner
✘
✘
FPPC Form 700 (2016/2017) Sch. CFPPC Advice Email: [email protected]
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
(Real property, car, boat, etc.) (Real property, car, boat, etc.)
SChEDuLE CIncome, Loans, & Business
Positions(Other than Gifts and Travel Payments)
GROSSINCOMERECEIvED No Income - Business Position Only No Income - Business Position OnlyGROSSINCOMERECEIvED
Name
OvER$100,000 OvER$100,000 $500 - $1,000 $500 - $1,000 $1,001 - $10,000 $1,001 - $10,000
$10,001 - $100,000 $10,001 - $100,000
700FAIr POLITICAL PrACTICES COMMISSION
CALIFORNIA FORM
► 1. INCOME rECEIVED NAMEOFSOuRCEOF INCOME
ADDRESS (Business Address Acceptable)
BuSINESSACTIvITY, IFANY,OFSOuRCE
YOuRBuSINESSPOSITION
► 1. INCOME rECEIVED NAMEOFSOuRCEOF INCOME
ADDRESS (Business Address Acceptable)
BuSINESSACTIvITY, IFANY,OFSOuRCE
YOuRBuSINESSPOSITION
NAME OF LENDER*
ADDRESS (Business Address Acceptable)
BuSINESSACTIvITY, IFANY,OFLENDER
INTERESTRATE TERM(Months/Years)
% None
HIGHESTBALANCEDuRINGREPORTINGPERIOD
$500 - $1,000
$1,001 - $10,000
$10,001 - $100,000
OvER$100,000
Comments:
► 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 retailinstallmentorcreditcardtransaction,madeinthelender’sregularcourseofbusinessontermsavailabletomembersofthepublicwithoutregardtoyourofficialstatus.Personalloansandloansreceivednotinalender’sregular course of business must be disclosed as follows:
SECuRITYFORLOAN
None Personal residence
Real Property
Guarantor
Other
Street address
City
(Describe)
CONSIDERATIONFORWHICHINCOMEWASRECEIvED Salary Spouse’sor registereddomesticpartner’s income
(For self-employed use Schedule A-2.)
Partnership (Less than 10% ownership. For 10% or greater use Schedule A-2.)
Sale of
Other
CONSIDERATIONFORWHICHINCOMEWASRECEIvED Salary Spouse’sor registereddomesticpartner’s income
(For self-employed use Schedule A-2.)
Partnership (Less than 10% ownership. For 10% or greater use Schedule A-2.)
Sale of
Other
(Describe) (Describe)
(Describe) (Describe)
Rental Income, list each source of $10,000 or more Rental Income, list each source of $10,000 or moreCommission or Commission or
Loan repayment Loan repayment
Lauren Miller Rogen
Universe at Sea Breeze LP
3150 Ocean St. Carlsbad, CA 92008
Real Estate Rental Property
Partner
✘
✘
Thursday,February23,2017at10:06:56AMPacificStandardTimeAmyCheung
Page1of1
Subject: No#fica#on-YourSubmi1edForm700Date: Thursday,February23,2017at9:41:18AMPacificStandardTimeFrom: [email protected]: LaurenMillerRogenCC: MariaBonneville,AmyCheung
Dear Lauren Miller Rogen, Congratulations! Your Statement of Economic Interest, Form 700 has been successfully filedwith our office on 02/23/2017 09:41 AM.
Electronic Confirmation #: 3129
Agency: California Institute of Regenerative MedicinePosition: ICOC Board MemberFiling Type: AnnualFiling Year: 2016Number of pages: 11
If you need to view, print or amend your filed form, a copy of your filing has been saved in yourprofile under 'Previous Filings' in the eDisclosure System. Hope you enjoyed your online filing experience. System Logon Link: https://form700.fppc.ca.gov/