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Home My WebLink AboutForm 460 - Eli Hill for San Rafael City Council D2; 12-31-21Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from 7/1/21 through 12/31/21 1. Type of Recipient Committee: All committees - complete Parts 1, 2, 3, and 4. m Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure O State Candidate Election Committee Committee O Recall O Controlled (Also Comp)ele Part 5) O Sponsored (Also Complete Pail 6) ❑ General Purpose Committee QSponsored ❑ Primarily Formed Candidate/ Small Contributor Committee Officeholder Committee Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER 1439056 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Eli Hill for San Rafael City Council D2 2022 STREET ADDRESS (NO P.O BOX) CITY STATE ZIP CODE AREACODE/PHONE San Rafael CA 94901 MAILING ADDRESS (IF DIFFERENT) NO.AND STREET OR P -O. BOX CITY STATE ZIP CODE AREACODE/PHONE OPTIONAL: FAX/E-MAILADDRESS 4. Verification D Date of election if app! (Month, Day, Year �+ 10/8/22 2. Type of Statement: COVER PAGE F 10 —1 2.022 agB 1 of 7 or Official Use Only CLERK'S OFFICE ❑ Preelection Statement Z Semi-annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) ❑ Quarterly Statement ❑ Special Odd -Year Report Treasurer(s) NAME OF TREASURER Eli Hill MAILING ADDRESS CITY STATE ZIP CODE AREACODE/PHONE San Rafael CA 94901 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREACODE/PHONE OPTIONAL: FAX/ E-MAIL ADDRESS I have used all 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. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and or Resnansihlr Officer of Sponsor Executed on Date By 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) Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Eli Hill for San Rafael City Council D2 2022 OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) San Rafael City Council RESIDENTIAL/BUSINESS ADDRESS (NO.ANDSTREET) CITY STATE GIP San Rafael CA 94901 Related Committees Not Included in this Statement: List any committees no: 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 STREET ADDRESS (NO P.0• 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 CODEIPHONE COVER PAGE - PART 2 Page 2 of 7 6. Primarily Formed Ballot Measure Committee NAME Oi BALLOT MEASURE 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 CandidatelOfficeholder Committee Listnames of offlcehofderfsj 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: adviceCMfppc.ca.gov (866/275-3772) www.fppc.ca.gov n Cam al Disclosure Statement Amounts may be rounded Campaign to whole dollars. Summary Page 5tatcriieltt.�do mrs fien from SUMMARY WAGE Expenditures Made To calculate Column B, 6. Payments Made................................................................ Schedule E, Line 4 12/31/21 Page 3 of 7 SEE INSTRUCTIONS ON REVERSE 0 8. SUBTOTAL CASH PAYMENTS . Add Lines 6+7 $ 2341 through .................. s—i.:.,........... Schedule F Line 3 0 NAME OF FILER Schedule C. Line 3 0 11. TOTAL EXPENDITURES MADE.. .................... ............ Add Lines 8+9+10 I.D. NUMBER Eli Hill filed for this calendar year, only carry over the amounts 1439056 from Lines 2, 7, and 9 (if Column A Column B Calendar Year Summary for Candidates Contributions Received FP.P.0 Advice: advice@fppc.ca.gov (866/275-3772) TOTAL THIS PERIOD CALENDARYEAR Running in Both the State Primary and (FROM ATTACHED SCHEDULES) TOTAL TO DATE General Elections 1. Monetary Contributions.......:........................................... schedule A, Line $ 3275 $ 10,275 1/1 through 6/30 7!1 to Date 2. Loans Received................................................................ schedule B, Line 3 0 0 3275 10,275 20. Contributions 10,275 3275 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 +2 $ $ Received $ $ 4. Nonmonetary Contributions ............................................ Schedule C, Line 3 0 0 21. Expenditures 332.63 $ 2341 5. TOTAL CONTRIBUTIONS RECEIVED ..... _.........�.............Add Lines 3+4 $ 3275 $ 10,275 Made $ Expenditures Made To calculate Column B, 6. Payments Made................................................................ Schedule E, Line 4 $ 2190,88 7. Loans Made........................................................................ Schedule H, Line 3 0 8. SUBTOTAL CASH PAYMENTS . Add Lines 6+7 $ 2341 9. Accrued Expenses (Unpaid Bills) .... . .................. s—i.:.,........... Schedule F Line 3 0 10. Nonmonetary Adjustment ...................... Schedule C. Line 3 0 11. TOTAL EXPENDITURES MADE.. .................... ............ Add Lines 8+9+10 $ 2341 Current Cash Statement 12. Beginning Cash Balance ................ Previous Summary Page, Line 16 $ 9938.37 13. Cash Receipts. Column A, Line 3 above 3275 .......................................................... 14. Miscellaneous Increases to Cash .. Schedule t, Line 4 0 15. Cash Payments......................................................... Column A, Line 8 above 2341 16. ENDING CASH BALANCE ...............Add Lines 12 + 13 + 14, then subtract Line 15 $ 10,872.37 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule B, Parte $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents. ................................ -- ......... See instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $ $. 332,63 0 $ 332.63 0 0 $ 332.63 Expenditure Limit Summary for State Candidates 22, Cumulative Expenditures Made* (If Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) To calculate Column B, add amounts in Column A to the corresponding *Amounts in this section may be different from amounts amounts from Column B reported in 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). FPPC Form 460 (Jan/2016)) FP.P.0 Advice: advice@fppc.ca.gov (866/275-3772) .. :gi'iFlSPl.fppe:.ca.rov Schedule A Amounts may be rounded Monetary Contributions Received to whole dollars. SEE INSTRUCTIONS ON REVERSE Statement covers period from 7/1/21 through 12/31/21 SCHEDULE A Page 4 of 7 NAME OF FILER I.D. NUMBER 11439056 Schedule A Summary 1. Amount received this period — itemized monetary contributions. 3275 (Include all Schedule A subtotals.).........................................................................................................$ 2. Amount received this period — unitemized monetary contributions of less than $100 ...........................$ 125 "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 3. Total monetary contributions received this period. 3275 (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.)......................TOTAL $ FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) FULL NAME, STREET ADDRESS AND ZIP CODE OF IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF COMMITTEE. ALSO ENTER I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) 7/4/21 Steven Chin m IND Unemployed 100 100 El COM ❑ OTH Sacramento, CA, 95829 ❑ PTY El SCC 7/7/21 Paul Attorney m IND Self, Attorney 500 500 COM E][1O OTH Yakima, WA,98907 ❑ PTY ❑ SCC 7/10/21 Brad Hill IND Social media 100 100 COM El11O OTH Normandy Park, WA, 98166 ❑ PTY ❑ scc 7/15/21 Alan Jones m IND AR Jones LLC / Consultant 1000 1000 El COM ❑ OTH Novato, CA,94947-5119 ❑ PTY ❑ SCC 8/6/21 Jason Jay m IND Lecturer, MIT 200 200 ❑ COM ❑ OTH Newton, MA 02460 ❑ PTY ❑ SCC SUBTOTAL $ 1900 Schedule A Summary 1. Amount received this period — itemized monetary contributions. 3275 (Include all Schedule A subtotals.).........................................................................................................$ 2. Amount received this period — unitemized monetary contributions of less than $100 ...........................$ 125 "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 3. Total monetary contributions received this period. 3275 (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.)......................TOTAL $ FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) &' —du.ie A (Continuatio,n-,Sheeat) Arnounts may be rounded SCHEDULE A (CONT.) Molletary Contributions Received to whole dollars. Statement covers period CALIFORNIA A i from 7/1/21 • through 12/31/21 Page 5 of 7 NAME OF FILER I.D. NUMBER j Eli Hill 1439056 lj FULL NAME, STREET ADDRESS AND ZIP CODE OF IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME) OF BUSINESS) PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) 9/1/21 Michael & Robert Chang & Herrig m IND Unemployed 150 150 El COM ❑ OTH Richmond, VA 23238 ❑ PTY ❑ ScC 11/23/21 Jess Gupta m IND Unemployed 1225 3675 ❑ CCM ❑ OTH San Anselmo, CA, 94960 ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC I ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH [❑PTY SCC SUBTOTAL $ 1375 "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 (866/275-3772) www.fppc.ca.gov Schedule E Payments Made NAME OF FILER Eli Hill Amounts may be rounded to whole dollars. Statement from 7/1/21 through 12/31/21 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. SCHEDULE E • , • •- Page 6 of 7 ,0. NUMBER 1439056 CMP campaign paraphemalia/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 (internet, e-mail) NAME AND ADDRESS OF PAYEE CODE OR (IF COMMrrTEE,ALSO ENTER I -D. NUMBER) Dyana Delfin Polk CNS Berkeley. CA94709 Rhett Jones Jr. CMP Oakland, CA 94605 Damon Connolly for Assembly CTB FPPC ID# 1441976 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. Schedule E Summary DESCRIPTION OF PAYMENT Campaign consultant Photography services Contribution to Damon Connely's campaign for Assembly AMOUNT PAID 1312.5 489 250 SUBTOTAL $ 2051.5 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 on 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.) ........................... TOTAL $ 2341 0 2341 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) . I www.fppc.ca.gov Schedule E (Continuation Sheet) Payments Madefrom Amounts may be rounded to whole dollars. Statement covers period 7/1/21 SCHEDULE E (CONT.) A , • ' - SEE INSTRUCTIONS ON REVERSE 139.38 DonorBox San Francisco, CA 94103 CMP Processing fees 150.12 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 289.5 FPPC Form 460 (!an 2016)1 FPPC Advice: advice@fppc.ca.gov (866/275-3772)