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Home My WebLink AboutForm 460 - Paramedic Services PAC (2015-12-31)Recipient Committee DN1StflnpCOVER PAGE Campaign Statement• 1 Cover Page n' Statement covers period from July 1, 2015 SEE INSTRUCTIONS ON REVERSE I through Dec. 31, 2015 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. ❑ Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Also Complete Part 5) 0 Sponsored (Also Complete Part 6) ❑ General Purpose Committee 0 Sponsored ❑ Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I I.D. NUMBER COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) 7 Committee for San Rafael Paramedic Services STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94903 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX/ E-MAIL ADDRESS Date of election if appliIII I JAN 2 8 2016 (Month, Day, Year) NA �� CLERK'S OFFI 2. Type of Statement: ❑ Preelection Statement ❑ Semi-annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) 3 of 33 For Oficial Use Only ❑ Quarterly Statement ❑ Special Odd -Year Report Treasurer(s) NAME OF TREASURER Greg Knell MAILING ADDRESS Same as Committee CITY STATE ZIP CODE AREACODEIPHONE 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 all reasonable diligence in preparing and reviewing this statement and to the best of my knowledgethe inforr oyft n d; herein and in the 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 correcj Y t, FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov 1/26/2015 Executed on By Date Sig r ure of Tre ur or Assistant Treasurer Executed on By Dale Signature of Controlling Office I r, Candidate, State Measure Proponent or Responsible Officer of Sponsor Executed on By Date Signature of Controlling Officeholder. Candidate, State Measure Proponent Executed on By Date 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 Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO. OR LETTER I JURISDICTION RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP Related Committees Not Included in this Statement: Listanycommittees 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 I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (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 STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE COVER PAGE - PART 2 Page of 33 ❑ 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 Listnames of officeholder(s) or candidate(s) for which this committee is primarily formed. 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 ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE Attach continuation sheets if necessary FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Amounts may be rounded to whole dollars. Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee for San Rafael Paramedic Services Contributions Received 1. Monetary Contributions................................................... Schedule A, Line 3 $ 2. Loans Received................................................................ Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 +2 $ 4. Nonmonetary Contributions ............................................ Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED .................................... Add Lines 3 + 4 $ Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) 0 0 1 11 Expenditures Made 6. Payments Made................................................................ Schedule E, Line 4 $ 50.00 7. Loans Made....................................................................... Schedule H, Line 3 0 8. SUBTOTAL CASH PAYMENTS .......................................... Add Lines 6+7 $ 50.00 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F Line 3 0 10. Nonmonetary Adjustment......................................................... Schedule C, Line 3 0 11. TOTAL EXPENDITURES MADE ........................................ Add Lines 8 +9 + 10 $ 50.00 Current Cash Statement S�9 Z ' 12. Beginning Cash Balance ............................ Previous summary Paye, Line 16 $ 13. Cash Receipts........................................................... Column A, Line 3 above 0 14. Miscellaneous Increases to Cash .................................. Schedule 1, Line 4 ,-.0 15. Cash Payments......................................................... Column A, Line 8 above S 00 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract line 15 $ 2 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule B, 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 $ Statement covers period from July 1, 2015 through Dec. 31, 2015 Column B CALENDAR YEAR TOTAL TO DATE 0 0 0 0 0 $ 50.00 0 $ 50.00 0 0 $ 50.00 To calculate Column B, add amounts in Column Ato the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative figures 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). SUMMARY PAGE Page 7 of 33 I.D. NUMBER Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6/30 7/1 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ IExpenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) 'Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEDULE H Schedule H Amounts may be rounded Statement covers period to whole dollars. Loans Made to Others July 1, 2015 . � � • ' from Dec. 31, 2015 33 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER Committee for San Rafael Paramedic Services FULL NAME, STREETADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER ° OUTSTANDING (b) AMOUNT (c) REPAYMENT OR (d) OUTSTANDING (e) INTEREST (t) ORIGINAL (g) CUMULATIVE OF RECIPIENT (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER BALANCE BEGINNING THIS LOANED THIS FORGIVENESS BALANCE AT OF THIS RECEIVED AMOUNT OF LOANS NAME OF BUSINESS) PERIOD PERIOD THIS PERIOD' PERIODCLOSE LOAN TO DATE ❑ PAID CALENDAR YEAR ❑ FORGIVEN RATE PER ELECTION"' S f f f f DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR s s x s s ❑ FORGIVEN RATE PER ELECTION' S f f S S DATE DUE DATE INCURRED 'Loans that are contributions to another candidate or committee must also be summarized on Schedule D. Loans forgiven must also be reported on Schedule E. SUBTOTALS $ $ $ $ (Enter (e) on Schedule I, Llne 3) Schedule H Summary 1. Loans made this period....................................................................................................................................................$ n (Total Column (b) plus unitemized loans of less than $100.) ..If Required 2. Payments received on loans............................................................................................................................................$ n (Total Column (c) plus unitemized payments of less than $100.) 3. Net change this period. (Subtract Line 2 from Line 1.)............................................................................................ NET $ n (Enter the net here and on the Summary Page, Column A, Line 7.) (May be anegaftanumber) FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule F Accrued Expenses (Unpaid Bills) NAME OF FILER Committee for San Rafael Paramedic Services Amounts may be rounded to whole dollars. SCHEDULE F Statement covers period CALIFORiAlA. ' from July 1, 2015 • " through Dec. 31, 2015 33 Page of I.D. NUMBER CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)• OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL Lv. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)' POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (Internet, e-mail) NAME AND ADDRESS OF CREDITOR (IF COMMITTEE. ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT ( OUTSTAA NDING BALANCE BEGINNING OF THIS PERIOD ( AMOUNT IN NCURRED THIS PERIOD (c) AMOUNT PAID THIS PERIOD (ALSO REPORT ON E) ( OUTSTANDING BALANCE AT CLOSE OF THIS PERIOD None Payments that are contributions or independent expenditures must also be SUBTOTALS $ $ $ $ summarized on Schedule D. 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 $100.) ..............................................INCURRED TOTALS $ 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 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 Summa Page, Column A, Line 9. ........... NET 0 May be a negative number 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 NAME OF FILER Committee for San Rafael Paramedic Services Amounts may be rounded to whole dollars. Statement covers period from July 1, 2015 through Dec. 31, 2015 I Page CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. SCHEDULE E of 33 CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)' OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)' POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (intemet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID California Secretary of State Annual Political Committee Fee Sacramento, CA 50.00 Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.)............................................................................................................. $ 50.00 2. Unitemized payments made this period of under $100.......................................................................................................................................... $ 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column(e).).............................................. 0 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ........................... TOTAL $ 50.00 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov