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Home My Public Portal AboutForm 460 (Campaign Statements) Ted Mertens 2022 (5)Recipient Committee Campaign Statement Cover Page SEE INSTRUCT30NS ON REVERSE Statement covers period from 10/23/2022 through 12/31/2022 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. m Officeholder, Candidate Controlled Committee O State Candidate Election Committee Q Recall (Also Complete PO 5) ❑ eneral Purpose Committee Sponsored 8 Small Contributor Committee Political Party/Central Committee E Primarily Formed Ballot Measure Committee U Controlled 0 Sponsored {Also Compte s Part 6) ❑ Primarily Formed Candidate/ Officeholder Committee (Atsa Cemplele Part]) Date of election if applicable: (Month, Day, Year) 11/08/2022 Date Stamp JAN L 2. Type of Statement: ❑ Preelection Statement m Semi-annual Statement m Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) COVER PAGE CALIFORNIA 460 FORM Page I of 8 For Official Use Only El Quarterly Statement ❑ Special Odd -Year Report 3. Committee Information I.D. NUMBER 1453220 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Elect Ted Mertens IW City Council 2022 STREET ADDRESS (NO P.O. BOX) 74972 Saguaro Lane CITY STATE ZIP CODE AREA CODE/PHONE Indian Wells CA 92210 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX 7607768186 CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX ! E-MAIL ADDRESS Treasurer(s) NAME OF TREASURER J.L. Mertens MAILING ADDRESS 74972 Saguaro Lane CITY Indian Wells STATE ZIP CODE CA 92210 AREA CODE/PHONE 7607768186 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS 4. Verification I have used MI reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules Is true and complete. certify under penalty of perjury under the laws of the State of California that the foregoing Treasurer 13y By Signature of Controlling Officeholder, Candidate, State Measure Proponent Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov COVER PAGE - PART 2 Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee CALIFORNIA 460 FORM V Page 2 of 8 NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE Ted Mertens. OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) City Council - City of Indian Wells RESIDENTIAL/BUSINESS ADDRESS (NO.AND STREET) CITY STATE ZIP 74972 Saguaro Lane Indian Wells CA 92210 Related Committees Not Included in this Statement: List any committees not included in this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME LO. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑YES NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) or candldate(s) for which this committee Is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ID SUPPORT • OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT • OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD • SUPPORT • OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD Mi SUPPORT ❑ OPPOSE Attach continuation sheets if necessary FPPC Farm 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE Amounts may be rounded to whole dollars. NAME OF FILER Elect Ted Mertens IW City Council 2022 Statement covers period from 10/23/2022 through 12/31/2022 SUMMARY PAGE Page 3 of 8 I.D. NUMBER 1453220 Contributions Received 1. Monetary Contributions 2. Loans Received 3. SUBTOTAL CASH CONTRIBUTIONS 4. Nonmonetary Contributions 5. TOTAL CONTRIBUTIONS RECEIVED Schedule A, Line 3 Schedule 8, Line 3 Add Lines 1 + 2 Schedule C, Line 3 ........Add Lines 3 + 4 Column A TOTAL THIS PER10❑ FROM ATTACHED SCHEOULES) $ 2332.00 -3000.00 $ -668 .00 0 $ -668.00 Column B CALENDAR YEAR TOTAL 70 DATE $ 5332.00 0 $ 5332.00 563.06 $ 5895.06 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 20. Contributions Received $ 21. Expenditures Made $ 1/1 through 6/30 $ 7/1 to Date Expenditures Made 6. Payments Made Schedule E, Line 4 $ 7. Loans Made Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS Add Lines 6+7 $ 9. Accrued Expenses (Unpaid Bills) Schedule F Line 3 10. Nonmonetary Adjustment Schedule C, Line 3 11. TOTAL EXPENDITURES MADE Add Lines 8+9+ 10 $ 637.58 0 637.58 -500.00 0 137.58 $ 5332.00 0 $ 5332,00 0 563.06 $ 5895.06 Current Cash Statement 12. Beginning, Cash Balance 13. Cash Receipts 14. Miscellaneous Increases to Cash 15. Cash Payments 16. ENDING CASH BALANCE Previous Summary Page, Line 16 Column A, Line 3 above Schedule 1, Line 4 Column A, Line 6 above Add Lines 12 + 13 + 14, then subtract Line 15 If this is a termination statement, Line 16 must be zero. $ 1305.58 -668.00 0 637.58 $ l) 17. LOAN GUARANTEES RECEIVED Schedule 8, Part 2 $ Cash Equivalents and Outstanding Debts 18, Cash Equivalents See instructions on reverse 19. Outstanding Debts Add Line 2 + Line 9 in Column B above $o To calculate Column B, add amounts in Column A to the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative fgures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made" Of Subject to Voluntary Expenditure Limitt Date of Election (mm/dd/yy) Total to Date 'Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2416)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A Monetary Contributions Received "' w""'C uu"°''' SEE INSTRUCTIONS ON REVERSE Statement covers period from 10/23/2022 CALIFORNIA FORM 460 through 12/31/2022 Page 4 of 8 NAME OF FILER Elect Ted Mertens IW City Council 2022 I.D. NUMBER 1453220 DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.O. NULIBER) CONTRIBUTOR CODE * IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OF SELF-EMPLOYED, ENTER NAME OF BUSINESS) AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 10/31/22 CREPAC #890106 c?o Reed & Davidson, LLP 515 S. Figueroa St., 110 T (lc iinraoloe re °fi1171 D IND El COM El OTH ❑ PTY 1000.00 1000.00 G SCC 11/14/2022 Fresh Agave Bar & Grill 73325mHighway 111 Palm Desert, CA 92260 ❑ IND E COM Z OTH 1000.00 1000.00 ■ PTY • scc El IND ❑ COM ■ OTH ❑ PTY El scc ❑ IND ❑ COM • OTH ❑ PTY ❑ scc [] IND ❑ COM • OTH • PTY ■ SCC Amounts may be rounded SCHEDULE A SUBTOTAL $ 2000.00 Schedule A Summary 1. Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.) 2. Amount received this period — unitemized monetary contributions of less than $100 3. Total monetary contributions received this period. 2000.00 $ 332.00 (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) TOTAL $ 2332.00 `Contributor Codes IND - Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SCC -Small Contributor Committee FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/2753772) www.fppc.ca.gov Schedule B — Part 1 Loans Received SEE INSTRUCTIONS ON REVERSE Amounts may be rounded to whole dollars. SCHEDULE B - PART 1 Statement covers period from 10/23/2022 through 12/31/2022 NAME OF FILER Elect Ted Mertens IW City Council 2022 FULL NAME, STREET ADDRESS AND ZIP CODE OF LENDER (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Ted Mertens 74972Saguaro Lane Indian Wells, CA 92210 t® IND 0 COM 0 OTH 0 PTV 0 SCC Ted Mertens 74972 Saguaro Lane Indian Wells, CA 92210 t® IND 0 COM 0 OTH 0 PTY 0 SCC t 0 IND 0 COM ❑ OTH 0 PTY 0 SCC IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) Retired Retired I®I OUTSTANDING BALANCE BEGINNING THIS PERIOD 1500.00 $ 1500.00 $ (b) AMOUNT RECEIVED THIS PERIOD $ 0 0 SUBTOTALS $ 0 (c) AMOUNT PAID OR FORGIVEN THIS PERIOD. ® PAID s 1500.00 0 FORGIVEN s PAID s 1500.00 ❑ FORGIVEN ❑ PAID ❑ FORGIVEN S OUTSTANDING BALANCE AT CLOSE OF THIS PERIOD 12/31/22 DATE DUE s 12/31/22 DATE DUE DATE DUE $ 3000.00 $ 0 INTEREST PAID THIS PERIOD 0 RATE 5 0 RATE 0 RATE $o CALIFORNIA FORM Page 5 of I.D. NUMBER 1453220 ORIGINAL AMOUNT OF LOAN $ 1500.00 8/26/22 DATE INCURRED $ 1500.00 9/26/22 DATE INCURRED DATE INCURRED g CUMULATIVE CONTRIBUTIONS TO DATE CALENDAR YEAR 1500.00 PER ELECTION* CALENDAR YEAR 3000.00 PER ELECTION` CALENDAR YEAR $ PER ELECTION"` Schedule B Summary 1. Loans received this period 0 (Total Column (b) plus unitemized loans of less than $100.) 2. Loans paid or forgiven this period (Total Column (c) plus loans under $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 3000.00 3. Net change this period. (Subtract Line 2 from Line 1.) NET $ Enter the net here and on the Summary Page, Column A, Line 2. `Amounts forgiven ar paid by another party also must be reported on Schedule A. " If required. $ 3000.00 (May be a negativa number) (Enter (e) on Schedule E, Line 3( tContributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Amounts may be rounded to whole dollars. Elect Ted Mertens IW City Council 2022 Statement covers period from 10/23/2022 through 12/31/2022 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP CNS CTB CVC FIL FND IND LEG LIT campaign paraphernalia/misc. campaign consultants contribution (explain nonmonelary)* civic donations candidate filing/ballot fees fundraising events independent expenditure supporting/apposing others (explain)` legal defense campaign literature and mailings MBR MTG OFC PET PHO POL POS PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) print ads RAD RFD SAL TEL TRC TRS TSF VOT WEB SCHEDULE E CALIFORNIA FORM Page 6 of 8 radio airtime and production costs returned contributions campaign workers' salaries t.v. or cable airtime and production costs candidate travel, lodging, and meals staff/spouse travel, lodging, and meals transfer between committees of the same candidate/sponsor voter registration information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER i.o. Num+zeal CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Chase Card Services - Visa P.O. Box 6294 411 S. Schur -tale Rd. Carol Stream, IL 60197-6294 Credit Card Payment 110.10 Subvendor: Costco #0038 (S24.89) 79797 Highway 111 La Quinta, CA 92253 FND Subvendor: Ralphs (810.00) 74884 Country Club Palm Desert, CA 92260 FND * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 110.10 Schedule E Summary 1 ,. Itemized payments made this period. (Include all Schedule E subtotals.) 2. Unitemized payments made this period of under $100 3. Total interest paid this period an loans. (Enter amount from Schedule B, Part 1, Column (e).) 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) $ 610.10 27.48 $ 0 TOTAL $ 637.58 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E (Continuation Sheet) Payments Made SEE INSTRUCTIONS ON REVERSE Amounts may be rounded to whole dollars. SCHEDULE E (CONT.) Statement covers period 10/23/2022 from through 12/31/2022 NAME OF FILER Elect ted Mertens IW City Council 2022 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP CNS CTB CVC FIL FND IND LEG LIT campaign paraphemalia/misc. campaign consultants contribution (explain nonmonetary)* civic donations candidate filing/ballot fees fundraising events independent expenditure supporting/opposing others (explain)` legal defense campaign literature and mailings MBR MTG OFC PET PHO POL POS PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) print ads RAD RFD SAL TEL TRC TRS TSF VOT WEB ALIFORNIA FORM 60 Page 7 of 8 I.D. NUMBER 1453220 radio airtime and production costs returned contributions campaign workers' salaries t.v. or cable airtime and production costs candidate travel, lodging, and meals staff/spouse travel, lodging, and meals transfer between committees of the same candidate/sponsor voter registration information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE OF COMMITTEE, Aso ENTER R I 1. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Subvendor:Mailchimp (S34.00) 675 Ponce de Leon Ave NE, Ste 5000 Atlanta, GA 30308 WEB Subvendor: Office Max ($41.21 79190 Highway 111 LA Ouinta, CA 92553 OFC Ted Mertens 74972 Saguaro Lane Indian Well's, CA 92210 FIL Reimburse Candidate Statement Fee 500.00 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 500.00 FPPC Form 460 Ilan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEDULE F Schedule F Accrued Expenses (Unpaid Bills) SEE INSTRUCTIONS ON REVERSE Amounts may be rounded to whole dollars. NAME OF FILER Elect Ted Mertens IW City Council 2022 Statement covers period from 10/2312022 through 12/31/2022 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphemalialmisc. MBR member communications CNS campaign consultants MTG meetings and appearances CTB contribution (explain nonmonetary)• OFC office expenses CVC civic donations PET petition circulating FIL candidate filing/ballot fees PHO phone banks FND fundraising events POL polling and survey research IND independent expenditure supporting/opposing others (explain)* PO5 postage, delivery and messenger services LEG legal defense PRO professional services (legal, accounting) LIT campaign literature and mailings PRT print ads CALIFORNIA FORM Page 8 of 8 I.D. NUMBER 145322t) RAD radio airtime and production costs RFD returned contributions SAL campaign workers' salaries TEL t.v. or cable airtime and production costs TRC candidate travel, lodging, and meals TRS staff/spouse travel, lodging, and meals TSF transfer between committees of the same candidate/sponsor VOT voter registration WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF CREDITOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT (a) OUTSTANDING BALANCE BEGINNING OF THIS PERIOD (b) AMO INCURRED THIS PERIOD (c) AMOUNT PAID THIS PERIOD (ALSO REPORT ON Ej (d) OUTSTANDING BALANCE AT CLOSE OF THIS PERIOD Ted Mertens 74972 Saguaro Lane Indian Wells, CA 92210 FIL 500.00 0 500.00 0 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTALS $ 500.00 $0 $ 500.00 $ 0 Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $1 00.) 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $1 00 or more, plus total unitemized payments on accrued expenses under $100.) PAID TOTALS $ 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.) NET $ INCURRED TOTALS $ 0 500.00 -500.00 May be a negative number FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov