803 Geoff Kors 2019-01-24 John F. Grundhofer Charitable FoundaitonBehested Payment Report A Public Document; ;
1. Elected Officer or CPUC Member (Last name, First name) I Date Stamp- -
Kors, Geoffrey
Agency Name 2 019 11 f,; 2 4 P+ i 12: 3 9
Palm Springs City Council
Agency Street Address
3200 E. Tahquitz Canyon Way
Designated Contact Person (Name and title, if different)
❑ Amendment (See Part 5)
Area Code/Phone Number E-mail (Optional) Date of Original Filing: _
7605370061 Geoff.kors@gmail.com
2. Payor Information (For additional payors, include an attachment with the names and addresses.)
John F. Grundhofer Charitable Foundation
Name
101 East 5th Street
Address
St. Paul
City
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
Mizell Senior Center
Behested Payment Report
For Official Use Only
(month, day, year)
MN 55101
State Zip Code
Name
480 S. Sunrise Way Palm Springs CA 92262
Address City State Zip Code
4. Payment Information (complete all information.)
Date of Payment: 01 /22/1029 Amount of Payment: on -Kind FMV) $ 10000
(month, day, year) (Round to whole dollars.)
Payment Type: ❑x Monetary Donation or ❑ In -Kind Goods or Services (Provide description below.)
Brief Description of In -Kind Payment:
Purpose: (Check one and provide description below.) ❑ Legislative ❑ Governmental
Describe the legislative, governmental, charitable purpose, or event:
Stars Among Us Event Sponsorship for Meals on Wheels Program
5. Amendment Description and/or Comments
6. Verification
0 Charitable
I certify, under penalty of perjury under the laws of the State of California, that to the best of my knowledge, the information contained
herein is true and complete.
Executed on
01 /24/2019
DATE
By
SIGNATURE OF ELECTED OFFICER OR CPUC MEMBER
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)