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460 Recipient Committee Campaign Statement - Semi Annual 7-1-21 to 12-31-21 AmendmentRecipient Committee COVER PAGE Campaign Statement Date Stamp CALIFORNIA I Cover Page ' RM SEE INSTRUCTIONS ON REVERSE Statement covers period from 01 /01 /2021 through 06/30/2021 1. Type of Recipient Committee: All Committees— Complete Parts 1, 29 3, and 4. Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure 3 State Candidate Election Committee Committee 3 Recall 0 Controlled (Also Complete Part 5) O Sponsored ❑ General Purpose Committee (Also Complete Part 6) 3 Sponsored ❑ Primarily Formed Candidate/ 3 Small Contributor Committee Officeholder Committee 3 Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I I.D. NUMBER 1369332 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Robert McCoy for Council 2020 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE Cupertino CA 95014 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY OPTIONAL: FAX / E-MAIL ADDRESS STATE ZIP CODE AREACODE/PHONE Date of election if applicable: (Month, Day, Year) 11 /03/2020 Filed Date- 01 /09/2022 07:16 PM Page 1 of 4 For Official Use Only 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement ./❑ Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement (Also file a Form 410 Termination) ./❑ Amendment (Explain below) Did not include one Expenditure transaction. Treasurer(s) NAME OF TREASURER Blossom McCoy MAILING ADDRESS CITY STATE Cupertino CA ZIP CODE AREACODE/PHONE 95014 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREACODE/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 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 correct. Executed on 01 /09/2022 By Date Signature of Treasurer or Assistant Treasurer Executed on 01 /09/2022 Date Executed on Date Executed on Date By Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Officer of Sponsor By Signature of Controlling Officeholder, Candidate, State Measure Proponent By oignacure or uoncrouing urncenoiaer, uanamace, ocace measure rroponenc 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 Robert McCoy OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP 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 ONO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑YES ONO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COVER PAGE - PART 2 Page 2 of 4 6. Primarily 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 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 01 /01 /2021 SUMMARY PAGE SEE INSTRUCTIONS ON REVERSE through 06/30/2021 Page 3 of 4 NAME OF FILER I.D. NUMBER Robert McCoy for Council 2020 1369332 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTAL THIS PERIOD CALENDAR YEAR Running in Both the State Prima and g Primary (FROM ATTACHED SCHEDULES) TOTAL TO DATE General Elections 1. Monetary Contributions ................................................ Schedule A, Line 3 $ 0.00 $ 0.00 1/1 through 6/30 7/1 to Date 2. Loans Received............................................................ Schedule a, Line 3 0.00 0.00 3. SUBTOTAL CASH CONTRIBUTIONS ............................. Add Lines 1 +2 $ 0.00 $ 0.00 20. ContributionsReceived $ $ 4. Nonmonetary Contributions ......................................... Schedule C, Line 3 0.00 0.00 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ............................ Add Lines 3+4 $ 0.00 $ 0.00 Made $ $ Expenditures Made 6. Payments Made.............................................................. Schedule e, Line 4 $ 7. Loans Made...................................................................... Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS ........................................ Add Lines 6+7 $ 9. Accrued Expenses (Unpaid Bills) ................................ Schedule F, Line 3 10. Nonmonetary Adjustment ............................................. Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ............................... Add Lines s + 9 + 10 $ current casn Statement 385.00 $ 385.00 0.00 0.00 385.00 $ 385.00 0.00 0.00 0.00 0.00 385.00 $ 385.00 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 5,566.00 To calculate Column B, 13. Cash Receipts.......................................................... Column A, Line 3 above 0.00 add amounts in Column A to the corresponding 14. Miscellaneous Increases to Cash ................................ Schedule 1, Line 4 0.00 amounts from Column B 15. Cash Payments........................................................ column A, Line s above 385.00 of your last report. Some amounts in Column A may 16. ENDING CASH BALANCE ...... Add Lines 12 + 13 + 14, then subtract Line 15 $ 5,181.00 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 re ort bein 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 $ p g 0.00 filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). 0.00 In 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 E,Y•la��l�J��q Schedule E Amounts may be rounded Statement covers period • - to whole dollars. Payments Made from 01/01/2021 • ' SEE INSTRUCTIONS ON REVERSE through 06/30/2021 Page 4 of 4 NAME OF FILER I.D. NUMBER Robert McCoy for Council 2020 1369332 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 RAID 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 FIND 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 SPRINT OFC 385.00 Los Angeles CA 900540977 Payments that are contributions or independent expenditures must also be summarized on Schedule D. 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).)...................................... 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.). SUBTOTAL $ 385.00 ............................. $ 385.00 ............................... $ 0.00 ............................. $ 0.00 ................ TOTAL $ 385.00 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov