RECEIVED

CAJ,.IFORNIA FORM 700

FAIR POUTICAl PRACTICES COMMISSION

A PUBLIC DOCUMENT

Please type or print in ink.

NAME OF FILER ILAST) IFiRST) IMIDDLE)

Pan Richard
1. Office, Agency, or Court
Agency Name
CA State Assembly
Division, Board, Department, District, if applicable Your Position
Assembly District 5 Assemblymember
... If filing for multiple positions, list below or on an attachment.

Agency: Position:

2. Jurisdiction of Office (Check at least one box)

~ State o Judge (Statewide Junsdiction)
o Multi-County _ _ _ _ _ _ _ _ _ _ _ _ _ __ o County of _ _ _ _ _ _ _ _ _ _ _ _ _ __
o Cilyof _ _ _ _ _ _ _ _ _ _ _ _ _ __ o Other
3. Type of Statement (Check at least one box)
~ Annual: The penod covered is January 1, 2010, through December 31, o Leaving Office: Date Left -----1-----1_ _
2010. -or- (Check one)
The period covered is -----1-----1_ _, through December 31, o The penod covered is January 1, 2010, through the dale of
2010. leaving office.

o Assuming Office: Date -----1-----1_ _ o The penod covered is -----1-----1_ _, through the dale
of leaving office.

o Candidate: Election Year _ _ _ _ __ Office sought, if different than Part 1: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

4. Schedule Summary
Check applicable schedules or fINone." .. Total number of pages including this cover page: _...;7__

~ Schedule A·l • Investments - schedule attached ~ Schedule C • Income, Loans, & Business Posffions - schedule attached
~ Schedule A·2 • Investments - schedule attached ~ Schedule 0 • Income - Gifts - schedule attached
o Schedule B • Real Properly - schedule attached ~ Schedule E • Income - Giffs - Travel Payments - schedule attached

·or·
o None· No reporlable interasts on any schedule

I certify under penally of perjury under the laws of the State of California tha

Date Signed ~ ti /25 \\

Imenlh, dey. Y'''i
Signatur

FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov

 SCHEDULE A-1
Investments
Stocks, Bonds, and Other Interests
(Ownership Interest is Less Than 10%)
AI
Do not attach brokerage or financial statements,

~rlf~BruE;;:~5'ifeql!lred'fiel(t.W

ExxcnMobil
Hewlett Packard
Petroleum, chemlcBI$ & ene-rID-
Technology
$2,000. $10,000
$2,000 - $1(1,000
'Stoc;k
<00' 1213112010
1213112010
John50n & Johnson Heatth care products & pharmaceuticals $2,000 - $10,000 Stoc;k 1213112010

HomeOepot
Mlcr050ft
Retail
TeclV1Ology
$2,000_$10.000
$2,000·SI0,ooO
'ro'"
Stock
Cisco Syslems Technology S2,000·SI0,ooO Stock

FPPC Form 100 (Z010/Z011) Sch, A-lx

FPPCTo1t·F,,,,, Helpline: 866!ASK_FPPC www,fppc,c.,i<'¥
 SCHEDULE A-2 CALIFORNIA FORM ~ 0'0
f~!j~~~~$'~IJ,~~~1S~~~~~q'~i~~~t~J~~!!t!
' , " -_~~""'''_'''_'~4_
Investments, Income, and Assets
of Business EntitieslTrusts
(Ownership Interest is 10% or Greater)
FAIR POLITICAL PRACTICES COMMISSION

Name
Richard Pan
l
* Select from drop down list

... _w ___ • __ ..
LIST DATE LIST DATE
NAME AND ADDRESS OF BUSINESS GENERAL NATURE OF PRO RATA LIST SINGLE INVESTMENT- REAL PROPERTY· NATURE OF
ACQUIRED YOUR ACQUIRED
ENTITY OR TRUST
(Business Address Acceptable)
DESCRIPTION OF
BUSINESS
FAIR MARKET
VALUE'
OR .,A INVESTMENT
(if "other,"
BUSINESS
SHARE OF
GROSS
SOURCES OF
[NCOMEOF
BUSINESS
ENTITY/NAME, AND
LIST PRECISE
LOCATION OF
FAIR MARKET
VALUE'
OR .,A INTEREST
(if "other,"
DISPOSED 0 POSITION DISPOSED 0
(If Trust, go to 2) ACTIVITY
(mmldd/2010j
describe)'
...INCOME TO
,.,., ...., ....... ,,""....
$10,000 OR MORE BUSINESS ACTIVITY REAL PROPERTY
(mm/dd/2010)
describe)·

Spouse-sole nfa
shareholder

co-owner Member 1$0.$499 4136 E.

LLC 1778 Itasca Ave. Sacramento Investment $1,000,000 Commerce Way $1,000,000
CA 95835 Sacramento, CA

FPPC Form 700 (2010/2011) 5ch. A-21

FPPCTolI-Free Helpline: 866/ASK-FPPC www.fppc.ca.go\
 SCHEDULE C CALIFORNIA FORM 700
Income, Loans, & Business FAIR POLITICAL PRACTICES COMMISSION

Positions Name/. r;)

(Other than Gifts and Travel Payments) j\ia It aA..' ;T;4;J'

!~B{a~~~lijlr~~k~d;f~ltr~~
_jL~\<~~ ,_ _ ~a=.-.:;;....~....u- .,-.
1)

* Select from drop down list

CONSIDERATION
GROSS FOR WHICH [NCOMEloF LENDER** (Business INTEREST SECURITY FOR LOAN
NAME AND ADDRESS BUSINESS YOUR BUSINESS BUSINESS HIGHEST TERM
INCOME WAS RECEIVED. Address Acceptable) RATE REAL PROPERTY
OF SOURCE ACTIVITY, IF ANY POSITION ACTIVITY, IF ANY BALANCE* (MosfYrs)
RECEIVED" (if "other," describe) AND GUARANTOR, IF (%) ADDRESS/OTHER INFORMATION·

Program consultant
Foundation, 1321 $10,000
Garden Hwy,
Sacramento, CA
95833

FPPC Form 700 (2010/2011) 5ch. C)

FPPCToll-Free Helpline: 866/ASK-FPPC www.fppc.ca.go\
 Schedule D
Income· Gifts

~~·~~WE~~~;';;f~~Uit~a'ff;~itliil
t1.~So.L;;;:;.:..4.;:"" ",",,'--"<_...;,';J.:.~....c;:u;~J

Speaker John A. Perez for

Assembly Los Angeles CA 90017
California Democratic Party 1401 21 rst St. Suite 200 Sacramento 12/05/10 $84.80 RecepUon- Stanford Mansion, Sacramento
CA 95811-5221
California Medical Association 1201 J Street Suite 200 Sacramento 12/06/10 $23.88 Reception Fallowing Swearing in Ceremony
CA 95814
California Restaurant Association 621 Capitol MalJ Suite 2000 12/15/10 $9.44 Reception-eRA Sacramento Chapter Mixer
Sacramento CA 95814
Accreditation Council on Graduate 515 N. State Street, Suite 2000 60654 12/15/10 $290 Award - Chair
Medical Education Chicago, Illinois

FPPC Form 700 (2010/2011) 5ch. Ox

FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov
 SCHEDULE E CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Income - Gifts
Travel Payments, Advances,
f:~~i9,~b;Jtl1V1~~;lp;-J::f-~S.:rdTl:0:t~r?:~?sj
l'-~M§zz e fyJ&~9.Y·ffi~:-J~L~Ljif0~:Jill and Reimbursements j
You are not required to report income from government agencies.

Income Transportation/lodging payments

for meeting attendance as Vice
California Medical Association 01/30/2010 $38.75 Income Transportation/lodging payments
Accreditation Council on Graduate Medical 217110-2/9/10 $ 1.112.00 Income Transportation/lodging payments
Education for meeting attendance as member
American Academy of Pediatrics 03/12/2010 $472.06 Income Transportation/lodging payments
American Medical Association 3/13-14/10 $1,353.77 Income Transportation/lodging payments
American Medical Association 06/10/2010 $1,087.33 Income Transportation/lodging payments
California Medical Association 7/30/10·8/1/10 $315.50 Income Transportation/lodging payments
Accreditation Council on Graduate Medical 09/27/2010 $1,000 Income Transportation/lodging payments
Education for meeting attendance as member
California Medical Association 10/1/10-10/4/10 $244.70 Income Transportationllodging payments
American Medical Association 11/4/2010- 11n/2010 $ 1,539.17 Income Transportation/lodging payments

FPPC Form 700 (20l0/20ll) Sch. Ex

FPPCToll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov
 Form 700x Comments

Schedules A-I through E Comments CALIFORNIA FORM

FAIR POLITICAl. PRACTICES COMMISSION
700
Name
Richard Pan

Patient information is confidential under Health Insurance Portability and Accountability Act of 1996 ("HIPAA"). To the best of my knowledge, I have not and will
not make, participate in making, or in any way attempt to use my official position to influence a governmental decision when to do so constituted or would
consitute a violation of Government Code section 87100 et seq.

~~,:",-:.-.p'~.7"'"'!T.,~
.............. eiiD~·Comments)(':·.:::;:'i'i;;;_.l§)kil
M,.-""",·,,,,,,·,,,,.. ;$i.'L'i.!i\ '~'? ,',' •• ,_.l ,,- .:..:.2::~!,"r·-1'· "...2

FPPC Form 700 (2010/2011) Comments

f:PPC Tnll_Frpp I-Ip[nfinp~ R66/ASK.FPPC WWW.fDDC.C;U!'OV