Hensley_Mark_2019_2020' ' STATEMENT OF ECONOMIC INTERESTS Date IFniti l Filing
uge Only
CALIFORNIA FORm7iling FAIR POLITICAL PRACTICES COMMISSION COVER PAGE
Filed Date: 09/22/2020 01:54 PM
Please type or print in ink. A PUBLIC DOCUMENT SAN: FPPC
NAME OF FILER (LAST) (FIRST) (MIDDLE)
Hensley Mark D
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of Monterey Park
Division, Board, Department, District, if applicable Your Position
City Attorney
P. 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 Monte
Park
3. Type of Statement (Check at least one box)
❑x Annual: The period covered is January 1, 2019, through
December 31, 2019.
-or-
The period covered is through
December 31, 2019.
❑ Assuming Office: Date assumed
❑ Candidate: Date of Election
❑ Judge, Retired Judge, Pro Tern Judge, or Court Commissioner
(Statewide Jurisdiction)
F-1 Cniinty of
❑ Other
❑ Leaving Office: Date Left
(Check one circle.)
O The period covered is January 1, 2019, through the date of
-or-
leaving office.
O 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: 5
Schedules attached
❑x 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 09/22/2020 01:54 PM
(month, day, year)
Signature Electronic Submission
(File the originally signed paper statement with your filing official.)
FPPC Form 700 -Cover Page(2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 5
STATEMENT OF ECONOMIC INTERESTS
COVER PAGE ATTACHMENT IName
++'
Mark Henslev
EXPANDED STATEMENT LIST
SCHEDULE A-1
Investments
Stocks, Bonds, and Other Interests
(Ownership Interest is Less Than 10%)
Investments must be itemized.
Do not attach brokeraae or financial statements.
► NAME OF BUSINESS ENTITY
KPMG Accounting Firm
GENERAL DESCRIPTION OF THIS BUSINESS
Accounting Firm
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
�X $100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT
Stock ❑ Other
(Describe)
0 Partnership 0 Income Received of $0 - $499
x0 Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
� / 19 19
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
$2,000 - $10,000 ❑ $10,001 - $100,000
$100,00, - $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:
// 19 // 19
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
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:
) 19 ) ) 19
ACQUIRED DISPOSED
Comments:
Name
Mark Hensley
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
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:
� / 19 19
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
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:
� / 19 19
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
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:
/ 19 ) ) 19
ACQUIRED DISPOSED
FPPC Form 700 - Schedule A-1 (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 7
SCHEDULE A-2 CALIFORNIA FORM700
Investments, Income, and Assets FAIR POLITICAL PRACTICES COMMISSION
of Business Entities/Trusts Name
(Ownership Interest is 10% or Greater) Mark Hensley
Hensley Law Group
Name
2600 W Olive Ave, Burbank CA 91505
Address (Business Address Acceptable)
Check one
❑ Trust, go to 2 ❑x 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 J---J 19 19
❑ $10,001 - $100,000 ACQUIRED DISPOSED
❑X $100,001 - $1,000,000
❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Partnership ❑X Sale Proprietorship ❑
Other
YOUR BUSINESS POSITION Owner
❑ $0 - $499 ❑ $10,001 - $1o0,0oo
❑ $500 - $1,000 ❑X OVER $100,000
❑ $1,001 - $10,000
❑X None or ❑ Names listed below
No- 4. INVESTMENTS • INTERESTS IN REAL PROPERTY• 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
❑ $10,001 - $100,000 19 19
❑ $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
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 / 19 19
❑ $10,001 - $10o,000 ACQUIRED DISPOSED
❑ $100,001 - $1,000,000
❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Partnership ❑ Sole Proprietorship ❑
YOUR BUSINESS POSITION
❑ $0 - $499 ❑ $10,001 - $100,000
❑ $500 - $1,000 ❑ OVER $100,000
❑ $1,0ol - $10,0oo
None or I I Names listed below
PROPERTY4. 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
❑ $10,001 - $100,000 19 ---J--J 19
❑ $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 (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 9
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
NAME OF SOURCE OF INCOME
KPMG Accounting Firm
ADDRESS (Business Address Acceptable)
355 S. Grand Ave, Los Angeles
BUSINESS ACTIVITY, IF ANY, OF SOURCE
Accounting Firm
YOUR BUSINESS POSITION
Partnership (spouse's business)
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑X 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.)
❑X 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
❑ Other
(Describe)
(Describe)
Name
Mark Hensley
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
❑ Loan repayment
❑ Commission or
❑ Other
(Real property, car, boat, etc.)
❑ Rental Income, list each source of $10,000 or more
(Describe)
(Describe)
* 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'
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY. IF ANY. OF LENDER
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $1,001 - $10,000
❑ $10,001 - $100,000
❑ OVER $100,000
Comments:
INTEREST RATE TERM (Months/Years)
% ❑ None
SECURITY FOR LOAN
❑ None ❑ Personal residence
❑ Real Property
❑ Guarantor
❑ Other
Street address
city
(Describe)
FPPC Form 700 - Schedule C (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 13