803 Geoff Kors 2019-05-30 Desert Oasis HealthcareBehested Payment Report
1. Elected Officer or CPUC Men
Kors, Geoffyt-7
Palm Springs City Council
3200 E. Tahquitz Canyon Way
7605370061
A Public Document
(Last name, First name) I Date Stamp
E-mail (optional)
30 Pi7 4: 43
❑ Amendment (see Pad 5)
Behested Payment Report
For Official Use Only
Date of Original Filing:
(month, day, year)
2. Payor Information (For additional payors, include an attachment with the names and addresses.)
Desert Oasis Healthcare
275 N. El Cielo Rd.
Palm Springs
City
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
Mizell Senior Center
480 S. Sunrise Way
Palm Springs
CA 92262
ate Zip Code
CA 92262
Address City State Zip Code
4. Payment Information (Complete alliniorma6on)
Date of Payment: 3141Y Amount of Payment: nn-rondFmv) $ 25,000
(month, day, year) (Round to whole dollars)
Payment Type: p Monetary Donation or ❑ In -Kind Goods or Services(Prawde descdpdon below.)
Brief Description of In -Kind Payment:
Purpose: (Check one and provide description below) ❑ Legislative ❑ Governmental I] Charitable
Describe the legislative, governmental, charitable purpose, or event:
Donation to Stars Among Us Gala for Meals on Wheels Program
5. Amendment Description and/or Comments
Information has been repeatedly requested and accounting was finally provided on 05/22/19
6. Verification
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 05/30/2019 By
DATE
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)