059
Date Accepted DO NOT MAIL THIS FORM TO THE FTB
TAXABLE YEAR FORMCalifornia e-file Return Authorization for 2021 8453-EOExempt Organizations
Exempt Organization name Identifying number
Part I Electronic Return Information (whole dollars only) 1 Total gross receipts (Form 199, line 4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 Total gross income (Form 199, line 8). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 Total expenses and disbursements (Form 199, line 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Part II Settle Your Account Electronically for Taxable Year 2021 4 Electronic funds withdrawal 4a Amount 4b Withdrawal date (mm/dd/yyyy) Part III Banking Information (Have you verified the exempt organization's banking information?) 5 Routing number
6 Account number Type of account: Checking Savings7
Part IV Declaration of Officer
I authorize the exempt organization's account to be settled as designated in Part II. If I check Part II, box 4, I authorize an electronic funds withdrawal for the amount listed on line 4a.
Under penalties of perjury, I declare that I am an officer of the above exempt organization and that the information I provided to my electronic return originator (ERO), transmitter, or intermediate service provider and the amounts in Part I above agree with the amounts on the corresponding lines of the exempt organization's 2021 California electronic return. To the best of my knowledge and belief, the exempt organization's return is true, correct, and complete. If the exempt organization is filing a balance due return, I understand that if the Franchise Tax Board (FTB) does not receive full and timely payment of the exempt organization's fee liability, the exempt organization will remain liable for the fee liability and all applicable interest and penalties. I authorize the exempt organization return and accompanying schedules and statements be transmitted to the FTB by the ERO, transmitter, or intermediate service provider. If the processing of the exempt organization's return or refund is delayed, I authorize the FTB to disclose to the ERO or intermediate service provider the reason(s) for the delay.
A ASign
Signature of officer Date TitleHere
Part V Declaration of Electronic Return Originator (ERO) and Paid Preparer. See instructions.
I declare that I have reviewed the above exempt organization's return and that the entries on form FTB 8453-EO are complete and correct to the best of my knowledge. (If I am only an intermediate service provider, I understand that I am not responsible for reviewing the exempt organization's return. I declare, however, that form FTB 8453-EO accurately reflects the data on the return.) I have obtained the organization officer's signature on form FTB 8453-EO before transmitting this return to the FTB; I have provided the organization officer with a copy of all forms and information that I will file with the FTB, and I have followed all other requirements described in FTB Pub. 1345, 2021 Handbook for Authorized e-file Providers. I will keep form FTB 8453-EO on file for four years from the due date of the return or four years from the date the exempt organization return is filed, whichever is later, and I will make a copy available to the FTB upon request. If I am also the paid preparer, under penalties of perjury, I declare that I have examined the above exempt organization's return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. I make this declaration based on all information of which I have knowledge.
Date ERO's PTINCheck if Check if
ERO's also paid self-Asignature preparer employed
ERO
Firm's FEIN
Firm's name (or yoursMust
if self-employed) ASign and address ZIP code
Under penalties of perjury, I declare that I have examined the above organization's return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. I make this declaration based on all information of which I have knowledge.
Date Paid preparer's PTINPaid
Check ifpreparer's A self-employedsignaturePaid
Preparer Firm's FEIN
Firm's nameMust A(or yours if self-Sign employed) and ZIP codeaddress FTB 8453-EO 2021
CAEA7001L 12/06/21
CITY OF SANTA CLARA PUBLIC FACILITIES 31-1611044
2,502,062.
2,502,062.
2,502,604.
DIR. OF FINANCE
XTIMOTHY J KRISCH, CPA P00283083
MAZE & ASSOCIATES
3478 BUSKIRK AVE STE 215 94-2590179
PLEASANT HILL CA 94523
DocuSign Envelope ID: 24538CF3-0BDF-43AC-9499-45F5B3B75E28 1/3/2023
□
□ □
□ I □ I
I
□
TAXABLE
YEAR
2021
Ca
liforn
ia
Exempt
Organ
ization
Annual
Information
Return
Calendar
Year
2021
or
fiscal
year
beginning
(mm/dd/yyyy)
7 / 0 1 /
2 0 21
, and
ending
(mm/dd/yyyy)
■
FORM 199
6/30/
2022
Corporation/Organization
name
CITY
OF
SANTA
CLARA
PUBLIC
FACILITIES
FINANCING
CORPORATION
Cal
iforn
ia
co
rporatio
n
nu
m
be
r
Additional
infor
ma
tion.
See
ins
truc
tions.
Stree
t address
(suit
e
or
room)
1500
WARBURTON
AVENUE
City SANTA
CLARA
Foreign
coun
try
name
D
Final
information
return?
I
No No No
• D
Dis
so
lved
D
Surrendered
(W
ith
drawn)
D
Merged/Reorg
anized
Enter
date:
(mm/
dd/yyyy)
•
E
Check
accounting
method:
-------
1 D
Cash
2 [R]
Ac
crua
l
3 D
Other
State CA Foreign
province/state/county
2011023 FEIN 31
-1611044
PM
S
no.
Zip
code
95050-3713 Foreign
postal
code
Did
the
organization
have
any
changes
to
its
guidelines
not
rep
orted
to
the
FTB?
See
instructions
. . . .
.
. .
.
•
D
Yes
J
If exempt
under
R&
TC
Section
2370
1 d,
has
the
organization
engaged
in
politica
l ac
tivities?
See
instructions.
. . .
. . . .
. . . . . . .
. . . .
•
D
Yes
K I
s the
organization
exempt
under
R&
TC
Section
2370
1 g? ..
•
0Yes
If "Yes,"
ente
r the gross
receipts
from
nonmember
sources.
. . .
. . .
. .
. . . . . . .
$
F
Federal
return
filed?
1 •
□
990
T
2 •
□
990-PF
3 •
□
Sc
h H (990)
---~~-~~-
•
0Yes
[R]
No
4 D
Other
990
series
G
Is
this
a group
filing?
See
instructions.
. .
. . . . . .
. . .
•
D
Yes
[R]
No
L
Is the
organization
a limited
liability
company?
..
M
Did
the organization
file
Form
100
or
Form
109
to
report
taxable
income?
. .
. . . .
. . . .
. . .
. ...
.. .
•
0Yes
[R]No
H
Is
this
organizat
ion
in
a group
exemp
tion
.....
If "Yes,"
what
is
the
parent's
name?
D
Yes
N
Is the
organization
under
audit
by
the
IRS
or
has
the
IRS
audited
in
a prior
year?.
. . .
. . .
. .....
.
•
0Yes
[R]No
0Yes
0No
O
Is
federal
Form
1023/
l 024
pending?
....
.....
...
..
... .
Date
filed
with
IRS
Part
I
Complete
Part
I unless
not
required
to
file
this
form.
See
General
Information
B
and
C.
1 Gross
sa
les
or receipts
from
other
sources.
From
Side
2,
Part
II,
line
8 ..
. . . . . . . . . .
'
....
. . . •
1 2,502,062.
2 Gross
du
es
and
assess
ments
from
m
embers
and
affil
iates.
...
. . . .
'
'
....
. . . . ...
.
'
.
'
•
2 Rece~rs
an
3 Gross
contributions,
gifts,
grants,
and
simi
lar am
ounts
rec
eived
.....
. . .
'
.. . ... .
'
. .
' .....
. . •
3 Revenues
4 Tota
l gross
receipts
for
filing
requirement
tes
t.
Add
line
1 through
line
3. This
line
must
be
completed.
If the
result
is
less
than
$50,000,
see
General
Information
B.
•
4 2
,502
,062
.
5 Cost
of
goods
so
ld ..
..
'
..
..
'
.
'
. '.
. . . . . . . .......
'
...
''.''
•
1 5
I
6 Cos
t or
other
basis,
and
sales
expenses
of
assets
so
ld ...
. ...
•I
6 I
j
7 Total
costs.
Add
line
5 and
lin
e 6
.
'
...
'.
'
..
'.
'
..
'
. . .
. . . . . . . .......
...
...
.....
....
....
7 8
Tota
l gross
in
come.
Subt
rac
t line
7 from
line
4 ...
. .
'
. .
'
'
. .
. . ..
.
,
''
..
. . . . . '.
. . . . . .
•
8 2
,502
,062
.
9 Tota
l expe
nses
and
disbursements.
From
Side
2,
Part
11,
line
18 .
'.
'
..
...
. . . . . . . . .
.
•
9 2
502
,604.
Expenses
10 Excess
of
receipts
over
expenses
and
disbursements.
Subtract
lin
e 9
from
line
8. 10
-542.
.
'
. . . '.
'
..
•
11 Tota
l payments
..
...
..
...
....
..
'
..
•
11 '.''.'.'.'.'
. . . .
'
. . . . . .
'.'
...
'.
'''.'.
12 Use
tax.
See
General
In
format
ion
K .
.
'
...
. .
'.'
...
'
.....
. . . . . . .
'
. . .
'
. . . .......
. •
12 13
Payments
balance.
If line
11 is
more
than
lin
e
12 , subtrac
t line
12 from
line
11 .. . . . ... .
•
13 Filing
14 Use
tax
balance
. If
line
12 is
more
than
line
11,
sub
tract
line
11 from
line
12. ....
'·
•·
''
.
•
14 Fee
15 Penalties
and
int
erest.
See
Gene
ral Information
J..
.
'
..
''.'
'
. . .
'.'
. . . . .
....
.
'
..
.
'
.
15 16
Bala
nc
e du
e.
Add
line
12 and
line
15 . Th
en
subtract
line
11 from
the
result.
. .
. . .
. . .
.
'
..
. ....
'
.@
16 0.
Sign
Under
penalties
of
perjury,
I declare
that
I have
examined
this
return,
including
accomfcanying
sc
hedules
and
statement
s,
and
to
the
bes
t of
my
knowledge
and
belief,
it
is
true,
correc
t,
and
complete.
Declaration
of
preparer
(other
tha
n
taxpayer)
is
based
on
all
in
orm
ation
of
which
preparer
ha
s
any
knowledge
.
Here
Signature
►
IT
itle
Date
•
Telephone
of
office
r
DIR
.
OF
FINANCE
( 408
\
615-2368
IDa
te
Check
if
•
PTIN
Prep
arer's
►
l:Z
·/..5'
•.lA
sel
f-
►□
Paid
signature
TIMOTHY
J
KRISCH
CPA
employed
P00283083
Preparer's
MAZE
ASSOCIATES
•
Firm's
FEIN
Firm'
s
name
&
Use
Only
(or
yours,
if
►
3478
BUSKIRK
AVE
STE
215
94 -2590
179
self
-employed)
•
Telephone
and
ad
dress
PLEASANT
HILL
CA
94523
925-930-0902
May
the
FTB
discuss
this
return
with
the
prepa
rer
shown
above?
See
instructions
.
...
...
'
.
'
...
....
•
IXI
Yes
I I No
■
CACA1112L
01/04/22
059
3651214
Form
199
2021
Side
1 ■
CITY
OF
SANTA
CLARA
PUBLIC
FACILITIES
31-1611044
Part
II
Organizations
with
gross
receipts
of
more
than
$50,000
and
private
foundations
regardless
of
amount
of
gross
receipts
-
complete
Part
II or
furnish
substitute
information.
1 Gross
sales
or
receipts
from
all
business
activities.
See
instructions
..
. .
.
.
'
...
.
'
...
2 Interest
..
''
'.'.'
. . .
'.
''
..
.....
3 Dividends.
''''.'.
Receipts
4 Gross
rents.
.
from
.
''.'
......
'
Other
5 Gross
royalties
..
'
..
'
'''.'.
'
..
'
..
. ...
,
..
'
Sources
6 Gross
amount
received
from
sale
of
assets
(See
instructions)
.
. .
.
7 Other
income.
Attach
schedule.
.
'.'.'.'
''.
'.
. ..
...
. ,$)1;~.
. $TAr~.M~l:J'.~
-~
8 Total
gross
sales
or
receipts
from
other
sources.
Add
line
1 through
line
7. Enter
here
and
on
Side
1,
Part
I, line
1. . . .
9 Contributions,
gifts,
grants,
and
similar
amounts
paid.
Attach
schedule
..
.
'.'
. . . .
'
.
'
..
..
'.
'
. .
'
..
'
10 Disbursements
to
or
for
members
....
'.'.'
'.'.'.
. .
,
..
'.'
. .
'.'.'
''.'
...
11 Compensation
of
officers,
directors,
and
trustees.
Attach
schedule.
SEE
STMT
2 '
..
',
. .
12 Other
salaries
and
wages
.
.
'.'''
..
. ..
Expenses
13 Interest.
and
''
''
..
'.''
..
'
..
'
..
Disburse-
14 Taxes
...
...
'
..
'
'''
..
''.'
. . .
. . .
.
'.''
. .
.
'.
ments
15 Rents.
''.
'.
''
..
.
'.'
'
....
,
. . .
.
'.'.
...
'.'
..
. ..
16 Depreciation
and
depletion
(See
instructions)
..
'.'.'
'
..
. . . . .
'.'.'.
''.'
.
17 Other
expenses
and
disbursements.
Attach
schedule
..
. . ,$)1;~
. $rAr~.M~l::JA.
.3
• • • • • • • . . . • • • • • • • • •
18 Total
expenses
and
disbursements.
Add
line
9 through
line
17. Enter
here
and
on
Side
1,
Part
I, line
9. ..
'
..
1 2
623
.
3 4 5 6 7
2,501,439.
8 2,502,062
.
9 10 11
0 .
12 13
496,439
.
14 15 16 17
2,006,165
.
18 2
502
604.
Schedule
L
Balance
Sheet
Beginning
of
taxable
year
End
of
taxable
year
Assets
(a)
(b)
(c)
(d)
1 Cash
..
.....
'.',.
723,083.
•
722,541.
2 Net
accounts
receivable
...
•
3 Net
notes
receivable
.
•
4 Inventories
.
•
5 Federal
and
state
government
obligations.
•
6 Investments
in
other
bonds
.
•
7 Investments
in
stock.
. . .
...
•
8 Mortgage
loans
..
...
''.'
•
9 Other
investments.
Attach
schedule
...
'
..
'
..
•
10 a
Depreciable
assets
........
. . . .
'.
'.,'
...
'''.'
b
Less
accumulated
depreciation
..
. . .
''
..
'.'
...
11 Land
....
.
''
..
'
'.'.'
.
'
..
'
..
''
..
...
'
..
'
..
•
12 Other
assets.
Attach
schedule
. . .
'.'.'
..
. _ST_M
4 13,653,691.
•
11,594,394.
13 Tota
I assets
..
. .
. '.
'
.
'.'
..
.
,
..
. ..
'
14,376,774.
12,316,935.
Liabilities
and
net
worth
14 Accounts
payable
.
•
15 Contributions,
gifts,
or
grants
payable
.
•
16 Bonds
and
notes
payable
..
. _S_T_.
5 12,588,691.
•
11,594,394.
17 Mortgages
payable
.
•
18 Other
liabilities.
Attach
schedule
. ...
. .
1,065,000.
19 Capital
stock
or
principal
fund
...
'.'.''
..
'
....
723,083.
•
722,541.
20 Paid-in
or
capital
surplus.
Attach
reconciliation
....
•
..
21 Retained
earnings
or
income
fund
..
'
.....
..
'
....
•
22 Total
liabilities
and
net
worth
.....
..
'.
. . . .
.
14,376,774.
12,316,935.
Schedule
M-1
Reconciliation
of
income
per
books
with
income
per
return
Do
not
complete
this
schedule
if
the
amount
on
Schedule
L,
line
13,
column
(d),
is
less
than
$50,000.
1 Net
income
per
books
.
•
-542.
7 Income
recorded
on
books
this
year
not
included
''.'
..
'
...
2 Federal
income
tax
.
•
in
this
return.
Attach
schedule.
•
..
'.'.'
3 Excess
of
capital
losses
over
capital
gains
.
•
8 Deductions
in
this
return
not
charged
4 Income
not
recorded
on
books
this
year.
against
book
income
this
year.
Attach
schedule
..
•
Attach
schedule
..
''
..
'
•
'
.
'
'
5 Expenses
recorded
on
books
this
year
not
deducted
9 Total.
Add
line
7 and
line
8 ....
''
..
in
this
return.
Attach
schedule.
•
10 Net
income
per
return.
.
'
.
'
..
. ..
6 Total.
Add
line
1 through
line
5 .
. .
. .
'
..
...
'
.
-542.
Subtract
line
9 from
line
6 ...
-542.
. .
■
Side
2 Form
199
2021
059
3652214
CACA
11 12L
O 1
/04/22
■
2021
STATEMENT
1 FORM
199,
PART
II,
LINE
7 OTHER
INCOME
CALIFORNIA
STATEMENTS
CITY
OF
SANTA
CLARA
PUBLIC
FACILITIES
FINANCING
CORPORATION
PROGRAM
SERVICE
REVENUE.
..
STATEMENT
2 FORM
199,
PART
II,
LINE
11 . .. .. ..
. $
TOTAL$
PAGE1 31-1611044
2,501,439. 2,501,439.
COMPENSATION
OF
OFFICERS,
DIRECTORS,
TRUSTEES
AND
KEY
EMPLOYEES
CURRENT
OFFICERS:
TITLE
AND
TOTAL
CONTRI-
EXPENSE
AVERAGE
HOURS
COMPEN-
BUTION
TO
ACCOUNT/
NAME
AND
ADDRESS
PER
WEEK
DEVOTED
SATION
EBP
&
DC
OTHER
KATHLEEN
WATANABE
BOARD
MEMBER
$
0. $
0. $
0. 1500
WARBURTON
AVENUE
0.50 SANTA
CLARA,
CA
95050-3713
KEVIN
PARK
BOARD
MEMBER
0. 0.
0. 1500
WARBURTON
AVENUE
0.50 SANTA
CLARA,
CA
95050-3713
RAJ
CHAHAL
BOARD
MEMBER
0. 0.
0. 1500
WARBURTON
AVENUE
0.50 SANTA
CLARA,
CA
95050-3713
KAREN
HARDY
BOARD
MEMBER
0. 0.
0. 1500
WARBURTON
AVENUE
0.50 SANTA
CLARA,
CA
95050-3713
ANTHONY
J.
BECKER
BOARD
MEMBER
0. 0.
0. 1500
WARBURTON
AVENUE
0.50 SANTA
CLARA,
CA
95050-3713
SUDHANSHU
JAIN
VICE
PRESIDENT
0. 0.
0. 1500
WARBURTON
AVENUE
0.50 SANTA
CLARA,
CA
95050-3713
LISA
M.
GILLMOR
PRESIDENT
0. 0.
0. 1500
WARBURTON
AVENUE
0.50 SANTA
CLARA,
CA
95050-3713
RAJEEV
BATRA
EXECUTIVE
DIR.
0. 0.
0. 1500
WARBURTON
AVENUE
0.10 SANTA
CLARA,
CA
95050-3713
KENN
LEE
DIR.
OF
FINANCE
0. 0.
0. 1500
WARBURTON
AVENUE
0.10 SANTA
CLARA,
CA
95050-3713
NORA
PIMENTAL
SECRETARY
0. 0.
0. 1500
WARBURTON
AVENUE
0.10 SANTA
CLARA,
CA
95050-3713
TOTAL$
0. $
0. $
0. 2021
STATEMENT
3 FORM
199,
PART
II,
LINE
17 OTHER
EXPENSES
CALIFORNIA
STATEMENTS
CITY
OF
SANT
A
CLARA
PUBLIC
FACILITIES
FINANCING
CORPORATION
BOND
COST
EXPENSE
.............
.
PRINCIPAL
DEBT
PAYMENTS
...
.
STATEMENT
4 FORM
199,
SCHEDULE
L,
LINE
12 OTHER
ASSETS
NET
INVESTMENT
IN
LEASE..
STATEMENT
5 FORM
199,
SCHEDULE
L,
LINE
16 BONDS
AND
NOTES
PAYABLE
TAX-EXEMPT
BONDS
PURPOSE
OF
ISSUE:
ISSUE
DATE:
ORIGINAL
ISSUE
AMOUNT:
TYPE
OF
FORM
FILED:
FORM
8038
FILING
DATE:
OUTSTANDING
ISSUE
AMT:
CENTRAL
PARK
LIBRARY
REFUNDING
3/28/2013 19,571,640. FORM
8038-G
3/28/2013
PAGE2 31-1611044
......
"""
$
1,165.
...
......
..
2,005,000.
TOTAL$
2,006,165. 11,594,394.
TOTAL$
11,594,394. BALANCE
DUE
11,594,394.
TOTAL
TAX-EXEMPT
BONDS$
11,594,394.
TOTAL
NOTES
AND
BONDS
PAYABLE$
11,594,394.