Disclosure Pursuant to the
City of Pasadena Taxpayer Protection Amendment
Pasadena City Charter, Article XVII
Contractor/Organization hereby discloses its trustees, directors, partners, officers, and those with more than 10% equity, participation, or revenue interest in Contractor/Organization, as follows:
(If printing, please print legibly. Use additional sheets as necessary.)
1. Contractor/Organization Name:The FID Group, dba Friends In Deed
2. Type of Entity:
D non-government X nonprofit 501(c)(3), (4), or (6)
3.Name(s) of trustees, directors, partners, officers of Contractor/Organization:
Bret Schaefer, President, Chief Financial Officer, Alzheimer's Foundation of LA Stacy Santeramo, Vice President, AVP, HR Operations, California Credit Union Christopher Pelch, Treasurer, Chief Operatinq Officer, Vance Wealth Debby Sinqer, Secretary, PJ Library Proqram Director, Jewish Federation of Greater San Gabriel and Pomona Valleys
Richard Cheuno D.D., ATC, Immediate Past President, Cheunq Chiropractic See attached paqe for remainino members
4. Names of those with more than 10% equity, participation or revenue interest in Contractor/Organization:
Prepared by: _Marty Campolo
Title: _Deputy D i recto r/G rants Officer
Phone:513-404-2442
Date: 9/17/23
8 {project.template.processClassification} - {project.title} Release Date: {project.releaseProjectDate}
PageS
Remaining Friends In Deed Board Members:
Pamela Marx, Retired, Supervising Attorney, Mental Health Advocacy Services Reverend Amadi (George) Mines, Minister
Ed Vidimos, Store Manager, Goodwill Industries
Tim Howett, Lawyer, Law Offices of Timothy Howett
Ervin Galvan, Owner, We Olive
Barbara Dangerfield, Formerly Homeless
Kevin Bourland, Real Estate Agent, John Arroe Group
Nishanthi Kurukulasuriya, Attorney, Disability Rights California Ursula Hyman, (Retired) Partner in the Los Angeles Office of Latham and Watkins JeffSalcido, Realtor, Compass
Leslie White, Principal Consultant, Lelo & Associates/Non-Profit Consultants Lana Slavitt, Consultant, Andrew M Slavitt, LLC
Rabbi Joshttn Leyine Grafer^Ewecttiiiie Direcfor
Marfx Campolo^Depttfx Direcfor
I
Disclosure Pursuant to the
City of Pasadena Taxpayer Protection Act
Pasadena City Charter, Article XVII
I. Does the value of this application/project have the potential to exceed $25,000? DYes @ II. Is the application being made on behalf of a government entity? DYes @ III. Is the application being made on behalf of a non-profit 501(c) organization? [ZlYes D No If yes, please indicate the type of 501 (c) organization: [Z]501(c)(3) D501(c)(4) D501(c)(6) (Applicant must mark one)
Applicant's name: Trinity Evangelical Lutheran Church
Owner's name: Trinity Evangelical Lutheran Church
Date of Application: November 29, 2023
Contact phone number: 626-792-1212
(for questions regarding this form)
Project Address: 997 E. Walnut St. Pasadena 91106
Project Description: Trinity Evangelical Lutheran Church will host the Pasadena Bad Weather Shelter operated by Friends Indeed.
I. Applicant and Property Owner must disclose all joint owners, trustees, directors, partners, officers and those with more than a 10% equity, participation or revenue interest in owner and/or project. If any of these are an organization/entity, include the name of the organization/entity and the first and last names of all parties of interest of that organization/entity. (List all parties below and use additional sheets as necessary, or provide all parties on an attachment) Please print legibly, hlave any additional sheets or an attachment been provided? D Yes Q No Names of Owner(s), Trustees, Directors,
Partners, Officers of Owner/Project
Names of Owner(s), Trustees, Directors,
Partners, Officers of Owner/Project
(continued)
Those with more than a 10% equity,
participation or revenue interest in Owner
and/or Project
Nancy Schmieder, Council PresidentVivian Lewis, Council member Maureen McConnell, Council VPDiane Harder, Financial Secretary Frances Hale, Treasurer
Rev. Sharon M. Ruff Richter, Pastor
Pamela Martin, Council Secretary
David Campfield, Council member
Wren Steifel, Council member
I hereby certify that I am the owner or designated agent and that the statements and answers contained herein, and the information attached, are in all respects true, accurate and complete to the be,s\ of my knojwledge and belief.
Signature of Owner or Designated Agent:Date: November 29. 2023 For Office Use Only
Type of Application: D Variance (all types) D Adjustment Permit d Sign Exception D Temporary Use Permit D Expressive Use Permit D Conditional Use Permit (excluding Master Plan) D Master Plan Amendment n Planned Development D Other Assigned Planner:
Attached Address:
PLN#:
Appealed: D Yes D No Appeal PLN#
D No Attached Address
D Application Withdrawn
Final Decision: D Approved D Denied Decision Date:
Votes in favor (please print):
Decision Maker:
(Name and Title, or Name ofCommission/Committee)
TPA Form - Rev 8/3/07