california form 700 statement of economic interests · the period covered is january 1, 2016,...

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











16 16 16 16

1616

161616

Name

►NAMEOFBuSINESSENTITY

GENERALDESCRIPTIONOFTHISBuSINESS











Comments:

SChEDuLE A-1Investments

Stocks,Bonds,andOther Interests(Ownership Interest isLessThan10%)

Do not attach brokerage or financial statements.


CALIFORNIA FORM

FPPC Form 700 (2016/2017) Sch. A-1FPPC Advice Email: [email protected]


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)


(Describe) Partnership IncomeReceivedof$0 -$499














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.)









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


FAIRMARKETvALuE $0 - $1,999 $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000




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


Check one Trust, go to 2 Business Entity, complete the box, then go to 2



►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





$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


Leasehold Other


Yrs. remaining

16 16

Other

NATuREOF INvESTMENT Partnership Sole Proprietorship

Other


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.


✘

Film & TV Production

✘

16 16

✘Corporation

owned by husband

✘

✘

Good Universe, NBC Universal, Mesquite Productions,Inc., Columbia Pictures Industries, Inc., Disaster ArtistLLC

16 16










16 16

16 1616 16

SChEDuLE A-2Investments, Income, and Assets

of Business Entities/Trusts(Ownership Interest is10%orGreater)

Comments:

Name


Name



















Name

700

Check one box: Check one box:

YOuRBuSINESSPOSITION YOuRBuSINESSPOSITION





$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


Leasehold Other


Yrs. remaining


Leasehold Other


Yrs. remaining

16 16

Other


Other


None Noneor or Names listed below Names listed below

Lauren Miller Rogen

Ketchup Chip, Inc.


✘

Writing and Acting Services

✘

16 16

✘Corporation

owned by husband

✘

✘

GEP Talent Services, LLC

16 16

Three Men and a Building LLC


✘

Real estate holding

✘ 16 16

✘

✘

✘

16 16

NAME OF LENDER*

ADDRESS (Business Address Acceptable)

BuSINESSACTIvITY, IFANY,OFLENDER





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:



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]



CALIFORNIA FORM

NAME OF LENDER*




% None

Guarantor, if applicable


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]


(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


CALIFORNIA FORM

► 1. INCOME rECEIVED NAMEOFSOuRCEOF INCOME


BuSINESSACTIvITY, IFANY,OFSOuRCE

YOuRBuSINESSPOSITION





NAME OF LENDER*




% None


$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




Sale of

Other

(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

✘

✘







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


CALIFORNIA FORM









NAME OF LENDER*




% None


$500 - $1,000

$1,001 - $10,000

$10,001 - $100,000

OvER$100,000

Comments:



SECuRITYFORLOAN


Real Property

Guarantor

Other

Street address

City

(Describe)




Sale of

Other




Sale of

Other





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

✘

✘







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


CALIFORNIA FORM









NAME OF LENDER*




% None


$500 - $1,000

$1,001 - $10,000

$10,001 - $100,000

OvER$100,000

Comments:



SECuRITYFORLOAN


Real Property

Guarantor

Other

Street address

City

(Describe)




Sale of

Other




Sale of

Other





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

✘

✘







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


CALIFORNIA FORM









NAME OF LENDER*




% None


$500 - $1,000

$1,001 - $10,000

$10,001 - $100,000

OvER$100,000

Comments:



SECuRITYFORLOAN


Real Property

Guarantor

Other

Street address

City

(Describe)




Sale of

Other




Sale of

Other





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

✘

✘







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


CALIFORNIA FORM









NAME OF LENDER*




% None


$500 - $1,000

$1,001 - $10,000

$10,001 - $100,000

OvER$100,000

Comments:



SECuRITYFORLOAN


Real Property

Guarantor

Other

Street address

City

(Describe)




Sale of

Other




Sale of

Other





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

✘

✘







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


CALIFORNIA FORM









NAME OF LENDER*




% None


$500 - $1,000

$1,001 - $10,000

$10,001 - $100,000

OvER$100,000

Comments:



SECuRITYFORLOAN


Real Property

Guarantor

Other

Street address

City

(Describe)




Sale of

Other




Sale of

Other





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/

https://form700.fppc.ca.gov/

california form 700 statement of economic interests · the period covered is january 1, 2016,...

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