STATEMENT OF ECONOMIC INTERESTS COVER PAGE
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1 A PUBLIC OCUMENT Please type or print in ink. STATEMENT OF ECONOMIC INTERESTS COVER PAGE ate Initial Filing Received Official Use Only Filed ate: 03/08/ :50 AM SAN: STH-0005 NAME OF FILER (LAST) (FIRST) (MILE) Hurley James 1. Office, Agency, or Court Agency (o not use acronyms) California Public Employees' Retirement System ivision, Board, epartment, istrict, if applicable Real Assets (RA) Your Position Investment irector ~ If filing for multiple positions, list below or on an attachment. Agency: SEE ATTACHE LIST (o not use acronyms) Position: 2. Jurisdiction of Office (Check at least one box) [lj State Judge or Court Commissioner (Statewide Jurisdiction) Multi-County County of 0 City of Other 3. Type of Statement (Check at least one box) [lj Annual: The period covered is January 1, 2015, through Leaving Office: ate Left J J ecember 31, (Check one) -or- The period covered is _J_Q_j~ 2015, through O The period covered is January 1, 2015, through the date of ecember 31, leaving office. -or- Assuming Office: ate assumed J J 0 The period covered is J J, through the date of leaving office. Candidate: Election year and office sought, if different than Part 1: 4. Schedule Summary (must complete) ~ Total number of pages including this cover page: 6 Schedules attached Ill Schedule A-1 Investments - schedule attached Schedule A-2 Investments - schedule attached Ill Schedule C Income, Loans, & Business Positions - schedule attached Schedule Income - Gifts - schedule attached 0 Schedule B - Real Property - schedule attached Schedule E - Income - Gifts - Travel Payments - schedule attached -or- None - No reportable interests on any schedule 5. Verification MAILING ARESS STREET CITY STATE ZIP COE (Business or Agency Address Recommended - Public ocument) 400 Q Street Sacramento CA 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. ate Signed 0_3/_0_8/_2_0_16_10_:_50_A_M (month, day, year) Signature -----~E=l=e=ct=r=o~n=ic~S~u=b=m~is=s~io=n~---- IFile the originally signed statement with your filing official.) FPPC Form 700 {2015/2016)
2 STATEMENT OF ECONOMIC INTERESTS COVER PAGE EXPANE STATEMENT LIST I
3 SCHEULE A-1 Investments Stocks, Bonds, and Other Interests (Ownership Interest is Less Than 10%) o not attach brokerage or financial statements. Cisco Global Exhange - Lithium $2,ooo - $10,000 Ill $10,001 - $100,000 $10,001 - $ Other Other M_; Q _j_j_ _ Corning J_j_j_ _ Hewlett Packard J_j_j_ _ $10,001 - $ $10,001 - $ Other Other First Trust NASAQ 100 Intel $10,001 - $ $2,ooo - $ Ill $10,001 - $100,000 Ill Stock Other J_j~...Qi_j Q _j_j_ _ Other FPPC Form 700 (2015/2016) Sch. A-1
4 SCHEULE A-1 Investments Stocks, Bonds, and Other Interests (Ownership Interest is Less Than 10%) o not attach brokerage or financial statements.!shares Brazil Vanguard Info Tech Mutual Fund $10,001 - $ $10,001 - $ Other Other j j 1 _ Powershares India j j 1 J_j 1 _ Verizon M_J_QL 1 _ $10,001 - $ $10,001 - $ Other Other J J 1 J J 1 _ Select Sector Util j_j 1 j_j 1 _ Schwab Emerging Markets $10,001 - $ $ $ Ill Stock Other J_j~ J_J 1 _ Other Q _j_l _j 1..1Q_j_Q _j 1 _ FPPC Form 700 (2015/2016) Sch. A-1
5 SCHEULE B Interests in Real Property (Including Rental Income) ~ ASSESSOR'S PARCEL NUMBER OR STREET ARESS 895 East Woodside #3 CITY Sacramento, Ca ~ ASSESSOR'S PARCEL NUMBER OR STREET ARESS CITY $2,ooo - $10,000 $ $ [lj $100,001 - $1,000,000 Q_ _j_jfu 1_ ) )~ $2,ooo - $10,000 $ $100,000 $100,001 - $1,000,000 ) )~ ) )~ NATURE OF INTEREST [lj Ownership/eed of Trust Easement NATURE OF INTEREST Ownership/eed of Trust Easement Leasehold Yrs. remaining Other Leasehold Yrs. remaining Other IF RENTAL PROPERTY, GROSS INCOME RECEIVE $0 - $499 $500 - $1,ooo [lj $1,001 - $10,000 $10,001 - $100,000 OVER $100,000 SOURCES OF RENTAL INCOME: If you own a 10% or greater interest, list the name of each tenant that is a single source of income of $10,000 or more. [lj None IF RENTAL PROPERTY, GROSS INCOME RECEIVE $0 - $499 $500 - $1,ooo $1,001 - $ $10,001 - $100,000 OVER $100,000 SOURCES OF RENTAL INCOME: If you own a 10% or greater interest, list the name of each tenant that is a single source of income of $10,000 or more. None * You are not required to report loans from commercial lending institutions 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 LENER* NAME OF LENER* ARESS (Business Address Acceptable) ARESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENER BUSINESS ACTIVITY, IF ANY, OF LENER INTEREST RATE TERM (Months/Years) INTEREST RATE TERM (Months/Years) % 0None % None HIGHEST BALANCE URING REPORTING PERIO $500 - $1,ooo $1,001 - $10,000 $10,001 - $100,000 OVER $100,000 Guarantor, if applicable HIGHEST BALANCE URING REPORTING PERIO $500 - $1,ooo $1,001 - $ $10,001 - $ OVER $100,000 Guarantor, if applicable Comments: ~ FPPC Form 700 (2015/2016) Sch. B
6 SCHEULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) ~ 1. INCOME RECEIVE NAME OF SOURCE OF INCOME Occidental Permian ARESS (Business Address Acceptable) PO Box Houston Tx BUSINESS ACTIVITY, IF ANY, OF SOURCE Oil Lease YOUR BUSINESS POSITION Limited Partner GROSS INCOME RECEIVE $500 - $1,ooo $1,001 - $10,000 Ill $10,001 - $100,000 OVER $100,000 CONSIERATION FOR WHICH INCOME WAS RECEIVE Salary Ill Spouse's or registered domestic partner's income (For self-employed use Schedule A-2.) ~ 1. INCOME RECEIVE NAME OF SOURCE OF INCOME The Place Within -- Folsom ARESS (Business Address Acceptable) 530 Plaza r #130 BUSINESS ACTIVITY, IF ANY, OF SOURCE Couseling YOUR BUSINESS POSITION Couselor GROSS INCOME RECEIVE $500 - $1,ooo Ill $1,001 - $10,000 $10,001 - $100,000 OVER $100,000 CONSIERATION FOR WHICH INCOME WAS RECEIVE Salary Ill 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.) 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 Sale of (Real property, car, boat, etc.) Loan repayment Commission or Rental Income, list each source of $10,000 or more Other Ot her ~ 2. LOANS RECEIVE OR OUTSTANING URING THE REPORTING PERIO * You are not required to report loans from commercial lending institutions, 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 LENER* INTEREST RATE TERM (Months/Years) ARESS (Business Address Acceptable) o/o 0None SECURITY FOR LOAN BUSINESS ACTIVITY, IF ANY, OF LENER None Personal residence HIGHEST BALANCE URING REPORTING PERIO $500 - $1,ooo $ $ $10,001 - $100,000 OVER $100,000 Real Property Street address Guarantor Other ~ City Comments: FPPC Form 700 (2015/2016) Sch. C
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