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450 Recipient Committee Campaign Statement Short Form - Semi Annual 7-1-23 to 12-31-23Recipient Committee SHORT FORM Campaign Statement - Short Form Date Stamp CALIFORNIA SEE INSTRUCTIONS ON REVERSE For use by recipient committees that have not received a contribution or other receipt that must be itemized, have not received or made loans, and have no outstanding accrued expenses. Statement covers period I Date of election if applicable: from 07/01/2023 (Month, Day, Year) through 12/31 /2023 1. Type of Recipient Committee: ❑ Ballot Measure Committee ❑� General Purpose Committee Q Primarily Formed (_/ Sponsored © Controlled ii Small Contributor Committee Q Sponsored ❑ Primarily Formed Candidate/ Officeholder Committee Filed Date: 01 /20/2024 09:45 PM ❑ Preelection Statement ❑./ Semi-annual Statement ❑ Termination Statement ❑ Amendment (Explain) (Also check type of statement you are amending) Page 1 of 3 For Official Use Only ❑ Quarterly Statement ❑ Special Odd -Year Report 3. Committee Information I o NUMBER 1455023 Treasurer(s) COMMITTEE NAME NAME OF TREASURER Cupertino Facts Xiangchen Xu MAILING ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIPCODE AREACODE/PHONE Cupertino CA 95014 ( CITY STATE ZIP CODE AREACODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Cupertino CA 95014 ( MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX MAILING ADDRESS CITY STATE ZIP CODE AREACODE/PHONE CITY STATE ZIP CODE AREACODE/PHONE Cupertino CA 95014 ( OPTIONAL: FAX / E-MAIL ADDRESS 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 the information contained herein is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on 01/20/2024 By DATE SIGNATURE OF TREASURER OR ASSISTANT TREASURER Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, 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 450 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (8661275.3772) www.fppc.ca.gov Recipient Committee Campaign Statement Summary Page Amounts may be rounded to whole dollars. Statement covers period from 07/01/2023 through 12/31/2023 Page 2 of 3 NAME OF COMMITTEE I.D. NUMBER Cupertino Facts 1455023 Expenditures Made 1. Expenditures of $100 or more made this period................................................................................................................................. 2. Expenditures under$100 made this period (Not itemized.)................................................................................................................ 3. SUBTOTAL EXPENDITURES MADE THIS PERIOD...........................................................................................................Add Lines 1 + 2 4. Nonmonetary Adjustment .........................................................................................................................................From Line 8 Below 5. Total expenditures made from previous statement.................................................................................Previous Summary Page, Line 6 (If this is the first statement for the calendar year, enter zero.) 6. TOTAL EXPENDITURES MADE TO DATE..................................................................................................................Add Lines 3 + 4 + 5 Contributions Received 7. Monetary contributions received this period........................................................................................................................................ 8. Non -monetary contributions received this period............................................................................................................................... 9. Total contributions received from previous statement...........................................................................Previous Summary Page, Line 10 (If this is the first statement for the calendar year, enter zero.) 10. TOTAL CONTRIBUTIONS RECEIVED TO DATE....................................................................................................... Add Lines 7 + 8 + 9 $ 194.00 0.00 $ 194.00 0.00 $ 0.00 $ 194.00 $ 0.00 0.00 $ 0.00 $ 0.00 Current Cash Statement 11. Beginning cash balance......................................................................................................................Previous Summary Page, Line 15 $ 911.53 12. Cash receipts this period......................................................................................................................................................Line 7 above 0.00 13. Miscellaneous increases to cash............................................................................................................................................................... $ 0.00 14. Cash expenditures this period..............................................................................................................................................Line 3 above 194.00 15. ENDING CASH BALANCE THIS PERIOD........................................................................Add Lines 11 + 12 + 13, then subtract Line 14 $ 717.53 FPPC Form 450 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SHORTFORM Recipient Committee Amounts may be rounded Campaign Statement — Short Form to whole dollars. SEE INSTRUCTIONS ON REVERSE Statement covers period from 07/01/2023 through 12/31/2023 Page 3 of 3 NAME OF COMMITTEE I I.D. NUMBER Cupertino Facts 1455023 55. Payments Made (If more space is needed, use additional copies of this page for continuation sheets.) DATE NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) DESCRIPTION OF PAYMENT NAME OF CANDIDATE AND OFFICE OR NAME OF BALLOT MEASURE AND BALLOT NUMBER OR LETTER AND JURISDICTION AMOUNT THIS PERIOD CUMULATIVE AMOUNTS TO DATE W 12/27/2023 USPS Cupertino CA 95015 mailbox rental 194.00 Calendar Year $ Other $ ❑support ❑ Oppose ❑ Contribution ❑ Ind. Exp. 0 Calendar Year Other $ ❑ Support ❑ Oppose ❑ Contribution ❑ Ind. Exp. 0 Calendar Year $ Other $ ❑ Support ❑ Oppose ❑ Contribution ❑ Ind. Exp. SUBTOTAL $ 194.00 FPPC Form 450 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov