Hensley, Mark - Form 700 2020-2021STATEMENT OF ECONOMIC INTERESTS Date Initial Filing Received
CALIFORNIA FORm7OO
Filing Official Use Only
FAIR POLITICAL PRACTICES COMMISSION COVER PAGE
A PUBLIC DOCUMENT Filed Date: 06/15/2021 01:34 PM
SAN:FPPC
Please type or print in ink.
NAME OF FILER (LAST) (FIRST) (MIDDLE)
Hensley Mark D
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of Chino Hills
Division, Board, Department, District, if applicable Your Position
City Attorney
► If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency: SEE ATTACHED LIST Position:
2. Jurisdiction of Office (Check at least one box)
❑ State
❑ Multi -County
❑x City of Chino Hills
3. Type of Statement (Check at least one box)
❑x Annual: The period covered is January 1, 2020, through
December 31, 2020.
.or -
The period covered is through
December 31, 2020.
❑ Assuming Office: Date assumed --J---J
❑ Candidate: Date of Election
❑ Judge, Retired Judge, Pro Tem Judge, or Court Commissioner
(Statewide Jurisdiction)
❑ County of
❑ Other
❑ Leaving Office: Date Left I
(Check one circle.)
O The period covered is January 1, 2020, through the date of
-or-
leaving office.
Q The period covered is through
the date of leaving office.
and office sought, if different than Part 1:
Schedule Summary (must complete) ► Total number of pages including this cover page: 4
Schedules attached
❑ Schedule A-1 - Investments — schedule attached
❑X Schedule A-2 - Investments — schedule attached
❑ Schedule B - Real Property — schedule attached
-or- ❑ None - No reportable interests on any schedule
5. Verification
❑x Schedule C - Income, Loans, & Business Positions — schedule attached
❑ Schedule D - Income — Gifts — schedule attached
❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
2600 W Olive Ave Ste 500 Burbank CA 91505-4572
DAYTIME TELEPHONE NUMBER EMAIL ADDRESS
( 310 ) 488-0782 mhensley@hensleylawgroup.com
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 California that the foregoing is true and correct.
Date Signed 06/15/2021 01:34 PM
(month, day, year)
Signature Electronic Submission
(File the originally signed paper statement with your filing official.)
FPPC Form 700 - Cover Page (2020/2021)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 5
STATEMENT OF ECONOMIC INTERESTS
COVER PAGE ATTACHMENT■N!"+
I Mark Hensley I
EXPANDED STATEMENT LIST
SCHEDULE A-2
Investments, Income, and Assets
of Business Entities/Trusts
(Ownership Interest is 10% or Greater)
IIN- 1. BUSINESS ENTITY OR TRUST
Hensley Law Group
Name
2600 W Olive Ave, Burbank CA 91505
Address (Business Address Acceptable)
Check one
❑ Trust, go to 2 Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
Law Practice
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $0 - $1,999
❑ $2,000 - $10,000 -/-/ 20 20
❑ $10,001 - $100,000 ACQUIRED DISPOSED
❑X $100,001 - $1,000,000
❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Partnership ❑X Sole Proprietorship ❑ Other
YOUR BUSINESS POSITION Owner
•• • • ••
SHARE OF -•SS INCOME TO THE ENTITY/TRUST)
❑ $0 - $499 ❑ $10,001 - $100,000
❑ $500 - $1,000 ❑X OVER $100,000
❑ $1,001 - $10,000
111 3. LIST THE NAME OF ••-TABLE SINGLE SOURCE OF
INCOME OF $10,000 OR MORE (Attach a separate sheet if necessary.)
❑X None or ❑ Names listed below
PROPERTYNo- 4. INVESTMENTS AND INTERESTS IN REAL •-
LEASED BY THE BUSINESS ENTITY •
Check one box:
❑ INVESTMENT ❑ REAL PROPERTY
Name of Business Entity, if Investment, or
Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity or
City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,001 - $100,000 20 20
❑ $100,001 - $1,000,000 ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OF INTEREST
❑ Property Ownership/Deed of Trust ❑ Stock ❑ Partnership
❑ Leasehold ❑ Other
Yrs. remaining
❑ Check box if additional schedules reporting investments or real property
are attached
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
10- 1. BUSINESS ENTITY OR TRUST
Name
Address (Business Address Acceptable)
Check one
❑ Trust, go to 2 ❑ Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $0 - $1,999
❑ $2,000 - $10,000 -/-/ 20 20
❑ $10,001 - $100,000 ACQUIRED DISPOSED
❑ $100,001 - $1,000,000
❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Partnership ❑ Sole Proprietorship ❑
Other
YOUR BUSINESS POSITION
SHARE OF ••SS INCOME TO THE ENTITY/TRUST)
❑ $0 - $499 ❑ $10,001 - $100,000
❑ $500 - $1,000 ❑ OVER $100,000
❑ $1,001 - $10,000
Do- 3. LIST THE NAME OF •••TABLE SINGLE SOURCE OF
INCOME OF $10,000 OR MORE (Attach a separate sheet if necessary.)
❑ None or ❑ Names listed below
PROPERTYNo- 4. INVESTMENTS AND INTERESTS IN REAL OR
LEASED BY THE BUSINESS ENTITY OR
Check one box:
❑ INVESTMENT ❑ REAL PROPERTY
Name of Business Entity, if Investment, or
Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity or
City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
7 $10,001 - $100,000 20 /( 20
❑ $100,001 - $1,000,000 ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OF INTEREST
❑ Property Ownership/Deed of Trust ❑ Stock ❑ Partnership
❑ Leasehold ❑ Other
Yrs. remaining
❑ Check box if additional schedules reporting investments or real property
are attached
Comments:
FPPC Form 700 -Schedule A-2(2020/2021)
advice@fppc.ca.gov • 566-275-3772 • www.fppc.ca.gov
Page - 9
SCHEDULE C Me'
Income, Loans, & BusinessPOSItIOnS Nam
(Other than Gifts and Travel Payments) Mark Hensley
NAME OF SOURCE OF INCOME
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary ❑ Spouse's or registered domestic partner's income
(For self-employed use Schedule A-2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
❑ Sale of
(Real property, car, boat, etc.)
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
NAME OF SOURCE OF INCOME
Pollak, Vida & Barer
ADDRESS (Business Address Acceptable)
11500 W Olympic Blvd, Suite 400, LA 90064
BUSINESS ACTIVITY, IF ANY, OF SOURCE
Law Firm
YOUR BUSINESS POSITION
Chief Financial Officer
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑X $10,001 - $100,000 ❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary X❑ Spouse's or registered domestic partner's income
(For self-employed use Schedule A-2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
❑ Sale of
(Real property, car, boat, etc.)
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
(Describe) (Describe)
❑ Other ❑ Other
(Describe) (Describe)
LOANS2. • • OUTSTANDING DURING THE REPORTINGPERIOD
* You are not required to report loans from a commercial lending institution, or any indebtedness created as part of
a retail installment or credit card transaction, 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` INTEREST RATE TERM (MonthsiYears)
% ❑ None
ADDRESS (Business Address Acceptable)
SECURITY FOR LOAN
BUSINESS ACTIVITY, IF ANY, OF LENDER ❑ None ❑ Personal residence
❑ Real Property
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $1,001 - $10,000
❑ $10,001 - $100,000
❑ OVER $100,000
Comments:
❑ Guarantor
❑ Other
Street address
city
(Describe)
FPPC Form 700 - Schedule C (2020/2021)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page -13