Statement Of Economic Interest For Principal Investigators {700-U} | Pdf Fpdf Docx | California

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Statement Of Economic Interest For Principal Investigators {700-U} | Pdf Fpdf Docx | California

Last updated: 5/2/2022

Statement Of Economic Interest For Principal Investigators {700-U}

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What is a Loan?Loans received or outstanding are reportable if they total $500 or more from a single lender. Your community property interest in loans received by your spouse or registered domestic partner also must be reported. Loans from commercial lending institutions made in the lender222s regular course of business on terms available to members reportable. (See Gov. Code Section 82030(a).)What is a Gift?A gift is anything of value for which you have not provided equal or greater consideration to the donor. A gift is reportable if its fair market value is $50 or more. In addition, multiple gifts totaling $50 or more received from a reportable source must be reported.It is the acceptance of a gift, not the ultimate use to which it is put, that imposes your reporting obligation. Therefore you must report a gift even if you never used it or if you gave it away to another person.If the exact amount of a gift is not known, you must make a good faith estimate of the item222s fair market value. Listing the value of a gift as 223over $50224 or 223value unknown224 is not adequate disclosure.Commonly reportable gifts include: þ Tickets/passes to sporting or entertainment events þ Tickets/passes to amusement parks þ Parking passes þ Food, beverages, and accommodations, including those provided in direct connection with your attendance at a convention, conference, meeting, social event, meal, or like gathering þ Rebates/discounts not made in the regular course of þfi status þ Wedding gifts þ þfi You may report an honorarium as income rather than as a gift if you provided services of equal or greater value than the payment received. þ Transportation and lodging þ Forgiveness of a loan received by you(See Gov. Code Section 82028.)FPPC Form 700-U (2018/2019)FPPC Advice Email: Toll-Free Helpline: 866/275-3772 Files Form 700-U? þfi or CSU who have principal responsibility for a research project if the project is to be funded or supported, in whole or in part, by a contract or grant (or other funds earmarked þfi þfi researcher) from a nongovernmental entity.Reporting requirements are outlined in Regulation 18755. This regulation provides that research funding by certain þfi is available on the FPPC website.What is the Reporting Period? þfi þfi and business positions with the sponsor as of the date that the award is made, and income and gifts received from the sponsor within the 12 months prior to the date that the award is made. þfi within 30 days after the contract, grant, or gift is renewed that discloses reportable investments, income and þfi þfi the date the project contract, grant, or gift was renewed.What is an Investment? þfi entity in which you, your spouse or registered domestic partner, or your dependent children have a direct, indirect, þfi investments include stocks, bonds, warrants, and options, including those held in margin or brokerage accounts. (See Gov. Code Section 82034 and Regulation 18237.)What is Income?223Income224 means a payment received, including but not limited to any salary, wage, advance, dividend, interest, rent, proceeds from any sale, gift, including any gift of food or beverage, loan forgiveness or payment of indebtedness þfi diem, or contribution to an insurance or pension program paid by any person other than an employer, and any community property interest in income of a spouse or registered domestic partner. Income also includes an outstanding loan. Income of an individual also includes a pro rata share of any income of any business entity or trust in which the individual, spouse, or registered domestic þfi interest or greater. Income includes your gross income and your community property interest in your spouse222s or registered domestic partner222s gross income totaling $500 or more. Gross income is the total amount of income before deducting expenses, losses, or taxes. (See Gov. Code Section 82030.)Instructions for Completing Form 700-U 700-UCALIFORNIAF þorOR M American LegalNet, Inc. þ þfi employee, or do you hold a position of management in the entity listed in Part 1? þ No þ Yes þ Title: þ Initial (for new funding) þ Date of initial funding: / / STATEMENT OF þEE CONOMIC þII NTERE þsS T þsSþFF ORPRINCI þpP AL þII NVE þsS TIGATOR þsS A Public DocumentN þaA M þeE (L þastAST ) þ (F þirstIRST ) þ ( þMiddleMIDDLE ) A þcadeCADE M þicIC U þnitNIT O þrR D þepartEPART M þentMailENT MAIL CO þdeDE ( ) þtelephTELEPH O þneNE þnuNU MB þerER FPPC Form 700-U (2018/2019)FPPC Advice Email: Toll-Free Helpline: 866/275-3772 Name of Entity: Address of Entity: Principal þBB usiness of Entity: Amount of Funding: $ Estimated þ Actual 3. þ Filer Information1. Information Regarding Funding Entity þ (Use a separate Form 700-U for each funding entity.)3. þ Filer Information - Cont. þeE -M þailAIL þaddressADDRESS Date ReceivedCampus Use OnlyPlease type or print in ink. 700-UF þairAIR P þoliOLI T þicalICAL P þracRAC T þiceICE S C þoO MM þiI SS þionION CALIFORNIA FOR þMM 2. þT T ype of þSS tatement (Check at least one box) þ Interim (for renewed funding) þ Funding was renewed on: / / E. þ Have you received gifts from the entity listed in Part 1 within the last 12 months valued at $50 or more? þ No þ Yes 226 describe below. þ Description: þ þ Value: $ þ Date Received: / / D. þ Have you received loans from the entity in Part 1 for which the balance exceeded $500 during the reporting period? þ No þ Yes 226 highest balance: $500 - $1,000 þ $1,001 - $10,000 $10,001 - $100,000 þ Exceeded $100,000If you checked 223yes,224 was the loan: Secured þ Unsecured þ Interest rate: Was the loan entirely repaid within the last 12 months? No þ YesCampus: ID No: þBB . þ Do you, your spouse or registered domestic partner, or your dependent children have an investment of $2,000 or more in the entity listed in Part 1 above? No þ Yes 226 value is: $2,000 - $10,000 þ $10,001 - $100,000 $100,001 - $1,000,000 þ Exceeds $1,000,000Date Disposed: / / , if applicableDescription and, if Gift, Travel Destination: Amt: þ $ þ date(s): þ / / þ / / þ (If gift)Type of Payment: (check one) þ þ Gift þ þ IncomeF. þ Has the entity in Part 1 paid for your travel during the reporting period? þ No þ Yes 226 describe below.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 certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.Date þSS igned (month, day, year) þSS ignature (File the originally signed statement with your university.)The Form 700-U is for university use only.This statement is a public record under Gov. Code Section 81008(a). T þitleITLE O þfF R þesearchESEARCH þprPR OJ þectECT C. þ Have you received income of $500 or more from the entity listed in Part 1 during the reporting period? þ No þ Yes 226 amount is: $500 - $1,000 þ $1,001 - $10,000 $10,001 - $100,000 þ Exceeds $100,000Was this income received through your spouse or registered domestic partner? No þ Yes American LegalNet, Inc. þ þfi entity exempt from taxation under Internal Revenue Service Code Section 501(c)(3) for which you provided equal or greater consideration, such as reimbursement for travel on business for a 501(c)(3) organization for which you are a board member.Check the box to indicate if the payment was a gift or income, report the amount, and disclose the date(s) if applicable.Violations þfi þfi þfi as University discipline. (See Gov. Code Sections 81000-91014.)Privacy Information NoticeInformation requested on all FPPC forms is used by the FPPC to administer and enforce the Political Reform Act (Gov. Code Sections 81000-91014 and Regulations 18110-18997). All information required by these forms is mandated by the Political Reform Act. Failure to provide all of the information required by the Act is a violation subject to administrative, criminal or civil prosecution. All reports and statements provided are public records open for public inspection and r

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