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Feeser, Nadia - Annual 2014-03-07CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION A PUBLIC DOCUMENT Please type or print in ink. NAME OF FILER Feeser Nadia Khattak 1. Office, Agency, or Court Agency Name (Do not use acronyms) City of Pismo Beach Division, Board, Department, District, if applicable Your Position Administrative Services Department Administrative Services Director (LAST) STATEMENT OF ECONOMIC INTERESTS COVER PAGE City of Pismo Beach Cid 4&--ge Or, mar Use Oay MAR 0 7 2014 Received (FIRST) (MIDDLE) ► If filing for multiple positions, list below or on an attachment. (Do not use acronyms) Agency Oversight Board to the former Pismo Beach RDA Position: Board member, Designated Contact Person 2. Jurisdiction of Office (Check at least one box) ❑ State El Multi -County LI City of Pismo Beach 3. Type of Statement (Check at least one box) • Annual: The period covered is January 1, 2013, through December 31, 2013. -or- The period covered is _/_/ December 31, 2013. ❑ Assuming Office: Date assumed , through ❑ Judge or Court Commissioner (Statewide Jurisdiction) ❑ County of ❑ Other ❑ Leaving Office: Date Left I I (Check one) p The period covered is January 1, 2013, through the date of leaving office. p The period covered is —J—J , through the date of leaving office. ❑ Candidate: Election year and office sought, if different than Part 1: 4. Schedule Summary Check applicable schedules or "None." • Schedule A-1 - Investments — schedule attached 10 Schedule A-2 - Investments — schedule attached © Schedule B - Real Property — schedule attached 5. Verification o -Total number of pages including this cover page: 6 ❑ Schedule C - Income, Loans, & Business Positions — schedule attached • Schedule D - Income — Gifts — schedule attached ❑ Schedule E • Income — Gifts — Travel Payments — schedule attached -or- None - No reportable interests on any schedule MAILING ADDRESS STREET (Business or Agency Address Recommend - Public Document) (p 0 M al -1i e r~ cul CITY STATE Z!P CODE Pismo Beach CA DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS (OPTIONAL) ( 805 ) 773-7010 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 foregoing is true and correct. 93449 Date Signed 03/07/2014 Signature --46.04 (month. day, year) (file the odginaty signed statement with your riling official ) FPPC Form 700 (2013/2014) FPPC Advice Email: advice@fppc.ca.gov FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov SCHEDULE A-1 Investments Stocks, Bonds, and Other Interests (Ownership Interest is Less Than 10%) Do not attach brokerage or financial statements. P. NAME OF BUSINESS ENTITY Echostar Corp GENERAL DESCRIPTION OF THIS BUSINESS CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION Name Nadia Feeser ► NAME OF BUSINESS ENTITY Roundy's GENERAL DESCRIPTION OF THIS BUSINESS global satellite services provider retail grocery company FAIR MARKET VALUE ▪ $2,000 - $10,000 0 $100,001 - $1,000,000 NATURE OF INVESTMENT ▪ Stock ❑ Other ❑ $10,001 - sioo.o00 ❑ Over $1,000,000 (Describe) ❑ Partnership 0 Income Received of $0 - $499 0 Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: 10)22/13 ��13 ACQUIRED DISPOSED ► NAME OF BUSINESS ENTITY Datalink Corp GENERAL DESCRIPTION OF THIS BUSINESS data center services and solutions provider FAIR MARKET VALUE ▪ $2,000 - $10,000 ❑ $10,001 - $100,000 ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT • Stock ❑ Other (Describe) ❑ Partnership 0 Income Received of $0 - $499 0 Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: 07 31)13 08/22/13 ACQUIRED DISPOSED ► NAME OF BUSINESS ENTITY Ultra Clean Holdings Inc. GENERAL DESCRIPTION OF THIS BUSINESS vertically integrated outsource manufacturer FAIR MARKET VALUE $2,000 - $10,000 0 $10,001 - $100,000 ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT IZ Stock ❑ Other (Describe) ❑ Partnership 0 Income Received of $0 - $499 0 Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: 07/10)13 10)07/13 ACQUIRED DISPOSED Comments: FAIR MARKET VALUE $2,000 - $10,000 ❑ $100,001 - $1,000,000 NATURE OF INVESTMENT ▪ Stock ❑ Other ❑ $10,001 - $100,000 ❑ Over $1,000,000 (Describe) 0 Partnership 0 Income Received of $0 - $499 0 Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: 10 24- _1_113 A- CQUIRED DISPOSED ► NAME OF BUSINESS ENTITY Netflix GENERAL DESCRIPTION OF THIS BUSINESS Internet television network FAIR MARKET VALUE $2,000 - $10,000 0 $100,001 - $1,000,000 NATURE OF INVESTMENT ▪ Stock ❑ Other ❑ $10,001 - $100,000 ❑ Over $1,000,000 (Describe) ❑ Partnership 0 Income Received of $0 - $499 0 Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: 04)19)13 11 )21 /13 ACQUIRED DISPOSED O. NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF THIS BUSINESS FAIR MARKET VALUE 0 $2,000 - $10,000 0 $100,001 - $1,000,000 NATURE OF INVESTMENT ❑ Stock ❑ Other ❑ $10,001 - $100,000 ❑ Over $1,000,000 (Describe) ❑ Partnership 0 Income Received of $0 - $499 0 Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: - _1 /13 AC- QUIRED DISPOSED FPPC Form 700 (2013/2014) 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 1147 Wisteria Lane CITY San Luis Obispo FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 $100,001 - $1,000,000 0 Over $1,000,000 IF APPLICABLE, LIST DATE: 13 / /13 ACQUIRED DISPOSED CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION Name Nadia Feeser P. ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS CITY FAIR MARKET VALUE 0 $2,000 - $10,000 0 $10,001 - $100,000 ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INTEREST NATURE OF INTEREST 21/Ownership/Deed of Trust O Leasehold IF APPLICABLE, LIST DATE: 13 / /13 ACQUIRED DISPOSED O Easement 0 Ownership/Deed of Trust 0 Easement ❑ ❑ Yrs. remaining Other Yrs. remaining Other 0 Leasehold IF RENTAL PROPERTY, GROSS INCOME RECEIVED 0 $0 - $499 ❑ $500 - $1,000 ❑ $1,001 - $10,000 0 $10,001 - $100,000 0 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. IF RENTAL PROPERTY, GROSS INCOME RECEIVED 0 SO - $499 0 5500 - $1,000 0 $1,001 - $10,000 0 $10,001 - 5100,000 ❑ 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 * 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* NAME OF LENDER* ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENDER BUSINESS ACTIVITY, IF ANY, OF LENDER INTEREST RATE TERM (Months/Years) INTEREST RATE TERM (Months/Years) % ❑ None % ❑ None HIGHEST BALANCE DURING REPORTING PERIOD HIGHEST BALANCE DURING REPORTING PERIOD O 5500 - $1,000 0 $10,001 - 5100,000 0 $1,001 - $10,000 0 OVER $100,000 ❑ $500 - $1,000 ❑ $10,001 - $100,000 0 Guarantor, if applicable ❑ Guarantor, if applicable Comments: ❑ $1,001 - $10,000 ❑ OVER $100,000 FPPC Form 700 (2013/2014) Sch. B FPPC Advice Email: advice@fppc.ca.gov FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov