Major Donor and Independent Expenditure Committee Campaign Statement Who Uses Form 461:* Major Donors • An individual or entity that makes monetary or nonmonetary contributions (including loans) to state or local officeholders, candidates, and committees totaling $10,000 or more in a calendar year. “Contribution” includes direct monetary contributions (e.g., tickets to campaign fundraisers), loan guarantees and loan forgiveness, nonmonetary contributions of goods or services, and discounts not provided to the public generally. Independent Expenditure Committees • An individual or entity that makes independent expenditures totaling $1,000 or more in a calendar year to support or oppose state or local candidates or ballot measures. An “independent expenditure” is an expenditure for a communication that expressly advocates the nomination, election or defeat of a clearly identified candidate or ballot measure that is not made to—or at the behest of—an officeholder, candidate, or committee. CALIFORNIA FORM Personal Contributions by Candidates and Officeholders: Form 461 is also required if, during a calendar year, a candidate or officeholder uses personal funds to make: • Contributions totaling $10,000 or more to other state or local candidates, officeholders or committees; or • Independent expenditures totaling $1,000 or more to support or oppose other state or local candidates, officeholders, or ballot measures. Contribution Limits: Candidates for elective state office are subject to contribution limits. Contributions received by committees for the purpose of making contributions to candidates for elective state office are also subject to limits. A chart identifying the limits is located at www.fppc.ca.gov. In addition, local candidates may be subject to contribution limits imposed by local ordinance. Questions about local limits should be directed to election officials in the local jurisdiction. 461 • Exceptions to the definition of “contribution” and “expenditure” for certain types of activities (e.g., volunteer personal services and communications to members of an organization) • Reporting “late contributions” and “late independent expenditures” made during the 16 days immediately prior to an election • Form 465–Supplemental Independent Expenditure Report • The Information Practices Act of 1977 This form was prepared by the Fair Political Practices Commission (FPPC). Campaign filing deadlines, forms, and other informational materials are available on the FPPC website (www.fppc.ca.gov). See reverse for general information on where to file this form. Additional Important Information: Refer to the FPPC Campaign Disclosure Manuals 5 and 6 for important information about: • When and where to file Form 461 *There are different forms and reporting requirements for committees that receive contributions totaling $1,000 or more during a calendar year (“recipient committees”). • Aggregation of contributions and expenditures by certain combinations of individuals and entities (e.g., parent and subsidiaries) FPPC Form 461 (March/2011) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) American LegalNet, Inc. www.FormsWorkFlow.com Instructions for Major Donor and Independent Expenditure Committee Campaign Statement Where to File: State Elections and Committees Active in More Than One County: If more than 50% of your contributions or independent expenditures were made to support or oppose state candidates, measures and committees, or to support or oppose local candidates and measures being voted on in more than one county. File in the following place: • Secretary of State (original and one copy) Political Reform Division 1500 11th Street, Room 495 Sacramento, CA 95814 Phone (916) 653-6224 Fax (916) 653-5045 www.sos.ca.gov CALIFORNIA FORM 461 City Elections: If you are not a state committee and more than 50% of your contributions or independent expenditures were made to support or oppose candidates and measures being voted on in a single city, file with the city clerk in that city (original and one copy). Electronic Filing: Major donor and independent expenditure committees that are required to file reports with the Secretary of State must file Form 461 electronically if they make contributions or independent expenditures totaling $25,000 or more in a calendar year. Paper reports are also required. Some local jurisdictions also require reports to be electronically filed. County Elections: If you are not a state committee and more than 50% of your contributions or independent expenditures were made to support or oppose candidates and measures being voted on in a single county, file with the election official in that county (original and one copy). This filing requirement also applies to contributions or independent expenditures made to support or oppose candidates and measures on the ballot in more than one jurisdiction located within a single county. FPPC Form 461 (March/2011) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) American LegalNet, Inc. www.FormsWorkFlow.com Major Donor and Independent Expenditure Committee Campaign Statement MAJOR DONOR AND INDEPENDENT EXPENDITURE COMMITTEE STATEMENT Type or print in ink. Date Stamp (Government Code sections 84200-84216.5) Statement covers period Date of election if applicable: (Month, Day, Year) of Page For Official Use Only from SEE INSTRUCTIONS ON REVERSE 461 CALIFORNIA FORM through 3. Summary 1. Name and Address of Filer NAME OF FILER (Amounts may be rounded to whole dollars.) RESIDENTIAL OR MAILING ADDRESS (NO. AND STREET) 1. Expenditures and contributions (including loans) of $100 or more made this period. (Part 5.)................................................ $ CITY STATE RESPONSIBLE OFFICER AREA CODE/DAYTIME PHONE ZIP CODE (If filer is other than an individual) 2. Nature and Interests of Filer (Complete each applicable section.) A FILER WHO IS AN INDIVIDUAL MUST LIST THE NAME, ADDRESS, AND BUSINESS INTERESTS OF EMPLOYER OR, IF SELF-EMPLOYED, THE NAME, ADDRESS, AND NATURE OF THE BUSINESS NAME OF EMPLOYER/BUSINESS BUSINESS INTERESTS ADDRESS OF EMPLOYER/BUSINESS A FILER THAT IS A BUSINESS ENTITY MUST DESCRIBE THE BUSINESS ACTIVITY IN WHICH IT IS ENGAGED A FILER THAT IS AN ASSOCIATION MUST PROVIDE A SPECIFIC DESCRIPTION OF ITS INTERESTS A FILER THAT IS NOT AN INDIVIDUAL, BUSINESS ENTITY, OR ASSOCIATION MUST DESCRIBE THE COMMON ECONOMIC INTEREST OF THE GROUP OR ENTITY Amendment (Explain): 2. Unitemized expenditures and contributions (including loans) under $100 made this period...................................................... $ 3. Total expenditures and contributions made this period. (Add Lines 1 + 2.) ................SUBTOTAL $ 4. Total expenditures and contributions made from prior statement. (Enter amount from Line 5 of last statement filed. If this is the first statement for the calendar year, enter zero.) ......................................... $ 5. Total expenditures and contributions (including loans) made since January 1 of the current calendar year. (Add Lines 3 + 4.)................................................... TOTAL $ 4. Verification I have used all reasonable diligence in preparing this statement. I have reviewed the 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 By DATE SIGNATURE OF INDIVIDUAL DONOR OR RESPONSIBLE OFFICER, IF OTHER THAN AN INDIVIDUAL FPPC Form 461 (March/2011) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) American LegalNet, Inc. www.FormsWorkFlow.com Instructions for Major Donor and Independent Expenditure Committee Campaign Statement CALIFORNIA FORM Period Covered by a Statement: corporation) that must be aggregated and reported on Form 461, list as the “Name of Filer” the name of the individual or entity that directs and controls the making of the contributions and independent expenditures. In addition, you must: The “period covered” by a campaign statement begins the day after the closing date of the last campaign statement you filed. For example, if the closing date of the last statement was June 30, the beginning date of the next statement will be July 1. • Indicate that the campaign statement includes the contributions and independent expenditures of other entities. For example, “ABC Corporation, including aggregated contributions/ independent expenditures.” For definitions and detailed information about completing Form 461, refer to the FPPC Campaign Disclosure Manuals 5 and 6. If this is the first campaign statement for the calendar year, begin with January 1. The closing date of the statement depends on the type of statement you are filing. Date of Election: Enter the date of the election if you are filing Form 461 as a city or a county major donor or independent expenditure committee and the city or county’s election will be held this year. 1. Name and Address of Filer: Enter the legal name of the individual or entity filing the statement. If the filer is commonly known to the public by another name, that name may be used. When a person directs and controls the making of contributions and independent expenditures by a related entity (e.g., a parent and subsidiaries or a majority shareholder of a • Identify any entities added to this report that were not included in a prior report filed for the current calendar year, as well as any entities included in a prior report for the current calendar year that are no longer required to aggregate under the name of filer. • Identify both names if the “Name of Filer” listed on a previous report filed for the current calendar year is different than the name identified on this report. For example, “John Lewis, formerly identified as Lewis Construction.” 461 3. Summary: Summary totals are calculated from the information itemized in Part 5 of the Form 461 and unitemized payments of less than $100. If this is the first report being filed for a calendar year, enter a zero on line 4 of the summary. 4. Verification: A responsible officer of an entity or an entity filing jointly with any number of affiliates must sign the Form 461. An attorney or a certified public accountant may sign on behalf of the entity or entities. A statement filed by an individual must be signed by the individual. Amendments: To amend previously filed Form 461, check the “Amendment” box, enter the period covered by the statement you are amending, and complete Part 1. Disclose the amended information, including Part 3, if applicable, and complete the Verification. Enter the name of the responsible officer of an entity or organization filing the statement. 2. Nature and Interests of Filer: When more than one person or entity is listed under “Name of Filer,” identify the nature and interests of each. (Use appropriately labeled continuation sheets if necessary.) FPPC Form 461 (March/2011) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) American LegalNet, Inc. www.FormsWorkFlow.com Major Donor and Independent Expenditure Committee Campaign Statement Type or print in ink. Amounts may be rounded to whole dollars. MAJOR DONOR AND INDEPENDENT EXPENDITURE COMMITTEE STATEMENT Statement covers period CALIFORNIA FORM from through SEE INSTRUCTIONS ON REVERSE NAME OF FILER Page 461 of 5. Contributions (Including Loans, Forgiveness of Loans, and Loan Guarantees) and Expenditures Made (If more space is needed, use additional copies of this page for continuation sheets.) DATE NAME, STREET ADDRESS, CITY, STATE AND ZIP CODE OF PAYEE TYPE OF PAYMENT DESCRIPTION OF PAYMENT (IF OTHER THAN MONETARY CONTRIBUTION OR LOAN) (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CANDIDATE AND OFFICE, MEASURE AND JURISDICTION, OR COMMITTEE AMOUNT THIS PERIOD CUMULATIVE AMOUNT RELATED TO THIS CANDIDATE, MEASURE, OR COMMITTEE Monetary Contribution Loan Non-Monetary Contribution Independent Expenditure Support Oppose Monetary Contribution Loan Non-Monetary Contribution Independent Expenditure Support Oppose Support Oppose Support Oppose Monetary Contribution Loan Non-Monetary Contribution Independent Expenditure Monetary Contribution Loan Non-Monetary Contribution Independent Expenditure SUBTOTAL $ FPPC Form 461 (March/2011) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) American LegalNet, Inc. www.FormsWorkFlow.com Instructions for Major Donor and Independent Expenditure Committee Campaign Statement 5. Contributions and Expenditures: When itemizing contributions and expenditures made by more than one entity (e.g., a parent and subsidiaries), note which entity made each payment. Date of Contribution A monetary contribution is made on the date it is mailed, delivered, or otherwise transmitted to the candidate or committee. A nonmonetary contribution is made on the earlier of the following: 1) the date you made an expenditure for goods or services at the behest of the candidate or committee; or 2) the date the candidate or committee or an agent of the candidate or committee obtained possession or control of the goods or services. Name and Address of Payee If a total of $100 or more is contributed or expended during a calendar year to support or oppose a single candidate, committee or measure, disclose the name and address of the payee. If the payee is a committee, also disclose the identification number assigned to that committee by the Secretary of State. If no ID number has been assigned to a committee, provide the name and address of that committee’s treasurer. Contributions and expenditures of less than $100 to support or oppose a single candidate, committee or measure during a calendar year are totaled and reported as a lump sum on Line 2 of the Summary. Candidate, Measure or Committee Identify the candidate, measure or committee supported or opposed by the contribution or expenditure. Disclose the name of the candidate and the office sought or held; the name of the ballot measure and its jurisdiction; or the name of CALIFORNIA FORM 461 the committee if a nonmonetary contribution was made to a general purpose committee. Check the appropriate box to indicate whether the payment was made to support or oppose the candidate or measure listed. Loans to state candidates are subject to contribution limits. If the candidate repays all or a portion of a loan, the lender may make additional contributions subject to the applicable contribution limit. Amount/Cumulative Amount Disclose the amount of the contribution or expenditure made this period. Non-Monetary Contributions: If a single payment supports or opposes more than one candidate or measure, provide the name and address of the vendor. Enter the amount paid to the vendor in the “Description of Payment” column. Identify each candidate or measure, and enter the amount of the contribution or expenditure attributable to each in the “Amount this Period” column. For each contribution, also disclose the cumulative amount contributed to the candidate (including all of the candidate’s controlled election committees) or to the committee (in the case of a ballot measure or other type of committee) since January 1 of the current calendar year. For each independent expenditure, disclose the cumulative amount of independent expenditures made since January 1 of the current calendar year related to the candidate or ballot measure supported or opposed by the expenditure. Reporting Loans: Check the “loan” box under “Type of Payment” if you make, forgive, or guarantee a loan. You need not report loan repayments received. If you make and forgive a loan during the same calendar year, report the amount of the forgiveness under “Description of Payment.” The same is true if you guarantee a loan and you make payments to the lender during the same calendar year. Report the fair market value of non-monetary contributions. The fair market value is the amount it would cost to purchase the goods or services on the open market, which may be more than the amount it cost to provide them. For example, the fair market value of donated catering services would normally be higher than the actual cost to the caterer. Reporting Subvendors: If an agent (including an independent contractor) makes payments on your behalf (“subvendor payments”), disclose those payments in addition to the payments made to the agent. For example, you pay a public relations firm, which pays for an advertisement supporting a ballot measure. In addition to disclosing the payment(s) made to the public relations firm, itemize payments of $500 or more made by the firm related to the advertisement. Do not include payments that are not for the purpose of making contributions or independent expenditures (e.g., for overhead or operating expenses). Report the name and address of the agent followed by the name and address of each subvendor. Disclose amounts paid to the agent and subvendor in the “Description of Payment” column. FPPC Form 461 (March/2011) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) American LegalNet, Inc. www.FormsWorkFlow.com