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Home My WebLink AboutForm 460 - Eli Hill for San Rafael City Council D2; 10-27-22 AmendedRecipient 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. W1 Officeholder, Candidate Controlled Committee 0 State Candidate Election Committee 0 Recall (Also Complete Part 5) ❑ General Purpose Committee 0 Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee ❑ Primarily Formed Ballot Measure Committee 0 Controlled 0 Sponsored (Also Complete Part 6) ❑ Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER 1439055 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Eli Hill for San Rafael City Council D2 2022 STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX! E-MAIL ADDRESS COVER PAGE G FIFT IE CALIFORNIA FOR of election if apF OCT 2 7 2022 Page 1 of (Month, Day, Ye For Official Use Only 11/8/22 CI CLERK'S OFFICE 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement l�] Semi-annual Statement ❑ Special Odd -Year Report L� Termination Statement (Also file a Form 410 Termination) u Amendment (Explain below) Amended to reflect adjusted expendature amount Treasurer(s) NAME OF TREASURER Eli Hill MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 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 knowledge herein and in the attached schedules is true and complete. I or 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) ......... c.._.. _, ..- 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 IFAPPLICABLE) San Rafael City Council RESIDENTIALIBUSINESSADDRESS (NO.ANDSTREET) CITY STATE ZIP San Rafael CA 94901 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 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) COVER PAGE - PART 2 Page 2 of 7 6. Primarilv Formed Ballot Measure Committee NAME OF 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 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 ul l T J Iml r- Lir I.UUt HKtH I.VUr-/rr1UNL 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 Summary Page Amounts may be rounded to whole dollars. Statement covers period from 7/1/21 SUMMARY PAGE SEE INSTRUCTIONS ON REVERSE through 12/31/21 Page 3 of 7 g NAME OF FILER I.D. NUMBER Eli Hill 1439056 Column A Column B Contributions Received TOTAL THIS PERIOD CALENDAR YEAR (FROM ATTACHED SCHEDULES) TOTAL TO DATE 1. Monetary Contributions................................................... Schedule A, Line 3 $ 3400 2. Loans Received................................................................ Schedule a, Line 3 0 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 +2 $ 3400 4. Nonmonetary Contributions ............................................ Schedule C, Line3 0 5. TOTAL CONTRIBUTIONS RECEIVED................................Add Lines 3+4 $ 3400 Expenditures Made 6. Payments Made ...... ..................... ................................. .... Schedule E, Line'4 $ 2341 7. Loans Made ............................ ......... _....... Schedule H, Line 3 0 8. SUBTOTAL CASH PAYMENTS ........................................ Add Lines 6+7 $ 2341 9. Accrued Expenses (Unpaid Bills Schedule F Line 3 0 10. Non monetary Adjustment ...... :......................... ...__... .. Schedule C, Line 3 0 11. TOTAL EXPENDITURES MADE..................................Add Lines 6+9+10 $ 2341 $ 10,400 0 $ 10,400 0 $ 10.400 $• 332,63 0 $ 332.63 0 0 $ 332.63 Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 9938.37 To calculate Column B, 13. Cash Receipts......... .......:......................................... 0 0 Ato the corresponding 14. Miscellaneous Increases to Cash............................ ..... Schedule I, Line 4 Schedule 1, Line 4 ashA amounts from Column B 15. Cash Payments...................................................... column A, Line a above 2341 of your last report. Someamounts in Column A may 16. ENDING CASH BALANCE ................ Add Lines 12 + 13 + 14, then subtract Line 15 $ 10 872.37 be negative figures that should be subtracted from If this is a termination statement, Line 16 must be zero. previous period amounts. If this is the first report being 17. LOAN GUARANTEES RECEIVED .......... ................. ..... Schedule e, Part 2 $ 0 filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if Cash Equivalents and Outstanding Debts V any). 18. Cash Equivalents ................................................ See instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column 8 above $ . 0 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6/30 7/1 to Date 20ContriReceibutions $ $t ons 10 400 4005 21 Made $ $ Expenditures denditures $ 332.63 $ 2341 i 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) *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 A Amounts may be rounded SCHEDULE A LO Wilde dollars. Monetary Contributions Received Statement covers period . - r from .7/1/21 INSTRUCTIONS through 12/31/21 Page 4 of 7 SEE ON REVERSE I.D. NUMBER NAME OF FILER 1439056 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED CONTRIBUTOR CONTRIBUTOR * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE CODE (IF SELF-EMPLOYED, ENTER NAME (IF COMMITTEE, ALSO ENTER I.D. NUMBER) OF BUSINESS) PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) 7/4/21 Steven Chin m IND Unemployed 100 100 ❑ COM ❑ OTH Sacramento, CA, 95829 ❑ PTY ❑ SCC 7/7/21 Paul Attorney m IND Self, Attorney 500 500 ❑ COM ❑ OTH Yakima, WA,98907 ❑ PTY ❑ SCC 7/10/21 Brad Hill W1 IND Social media 100 100 El COM❑ OTH Normandy Park, WA, 98166 ❑ PTY ❑ SCC 7/15/21 Alan Jones Z IND AR Jones LLC / Consultant 1000 1000 ❑ COM ❑ OTH Novato, CA,94947-5119 ❑ PTY ❑ SCC 8/6/21 Jason Jay Z 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 3. Total monetary contributions received this period. 3400 (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.)......................TOTAL $ "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) .........:--- -- --.. Schedule A (Continuation Sheet) Monetary Contributions Received WE OF Eli Hill Amounts may be rounded to whole dollars. SCHEDULE A (CONT.) Statement covers period CALIFORNIA from 7/1/21 FORM 460 0 through 12/31/21 Page 5 of 7 I.D. NUMBER 1439056 *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 FULL NAME, STREETADDRESS 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 IND Unemployed 150 150 ❑ COM ❑ OTH Richmond, VA 23238 ❑ PTY I ❑ SCC J 11/23/21 Jess Gupta m IND - Unemployed 1225 3675 ❑ COM ❑ OTH San Anselmo, CA, 94960 ❑ PTY ❑ SCC J ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY F-1 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 SEE INSTRUCTIONS ON REVERSE NAME OF FILER Eli Hill Amounts may be rounded to whole dollars: CODES: If one of the following codes accurately describes the payment, you may enter the code CMP campaign paraphernalia/misc. 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)* POS Postage, delivery and messenger services LEG legal defense PRO professional services (legal, accounting) LIT campaign literature and mailings PRT print ads from 711121 through 12/31/21 Otherwise, describe the payment. SCHEDULE E Page 6 of 7 I.D. NUMBER 1439056 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 PAYEE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Dyana Delfin Polk CNS Campaign consultant 1312.5 Berkeley, CA94709 Rhett Jones Jr. CMP Photography services 489 Oakland, CA 94605 Damon Connolly for Assembly CTB Contribution to Damon Connely's campaign for Assembly 250 FPPC ID# 1441976 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 2051.5 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 on loans. (Enter amount from Schedule B, Part 1, Column (e).). .................................... $ ........................................... $ 2341 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 $ 2341 FPPC Form 460 (!an/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID SCHEDULE E (CONT.) CMP Amounts may be rounded Statement covers period . (Continuation Sheet) 150.12 to whole dollars. � • Payments Made from 7�1�21 through 1213.1L21 page 7 SEE INSTRUCTIONS ON REVERSE of NAME OF FILER I.D. NUMBER Eli Hill 1439056 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 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 (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID ScanArt Emervville, CA 94608 CMP Window signs 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 Ian 2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) WWW fnnr ra anv