Rachel Schuster 12/31/2012 • •
[� MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673 -7411, Fax: (305) 673 -7254
11 -22 -2010
Rachel Schuster
3035 Royal Palm Ave.
Miami Beach, Florida 33140
'SE.I_BjEciraV Health Advisory Committee
Congratulations! You have been appointed by the City Commission to the agency,
board or committee named above for a term ending: 12/31/2012.
Pursuant to Ordinance No. 2006 -3543, commencing with terms beginning on or after
January 1st, 2007, the term of board members who are directly appointed by a member of
the City Commission shall automatically expire on December 31 of the year the appointing
elected official leaves office.
If you are unable to accept this appointment or have any questions, please call the City
Clerk's Office at 305 - 673 -7411. Please read the enclosed materials carefully.
Congratulations again and good luck.
Sincerely,
U(t, Robert Parcher
City Clerk
cc: Saul Frances, Parking Director
Cliff Leonard
ATTACHMENTS:
Letter of Appointment
Oath
City Code Ordinance section, applicable to agency, board or committee
City Code Section 2 -22, 2 -23, 2 -24, 2 -25, 2 -26, 2-458 and 2-459
Ordinance No. 2006 -3543 - Amendment to City Code Section 2 -22
Miami -Dade County Code Section 2 -11.1 - Conflict of Interest and Code of Ethics Ordinance
City Wide Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employee
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
•
M IAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachLgov
OFFICE OF THE CITY CLERK, Robert Parcher, City Clerk
Tel: (305) 673-7/111, Fax: (305)673 -7254
TO Rachel Schuster
RE: Health Advisory Committee
I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the Government of the
United States, the State of Florida, and the City of Miami Beach, and to perform all the duties of
a member of the above - mentioned board or committee of the City of Miami Beach to which I have
been appointed for a term ending: 12/31/2012.
I have been issued a copy of Section 2 -11.1 of the Miami -Dade County Code (Conflict of Interest
and Code of Ethics Ordinance), as well as theF /orida Commission on Ethics Guide to the Sunshine
Amendment and Code of Ethics for Public Officers and Employees, and understand that as a member
of a City of Miami Beach Board and /or Committee, I must comply with the financial disclosure* require-
ments of Miami -Dade County or the State of Florida (depending on the board or committee on which
I serve)' on July 1st, following the closing of the calendar year on which I have served.
,A / S40 11..'
Rachel Schuster
Sworn to and subscribed before me this r day of 0Q foist i , 010. •
0 6 / . --- Maria E. Ma Inez
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and Committees
for additional information regarding the Financial Disclosure Requirements.
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
1 idigh
t\AIAt\AI BEACH r
OF MIAMI BEACH
iii.
BOARDS AND COMMITTEE APPLICATION FORM
NAME: SGfltA S }P ( rear h o 1
Last Name / First Name Middle Initial
HOME ADDRESS: 3033 b10 P,► I M MV. P'11 /011; QY a c. C7. 3314
No. Street City State Zip Code
PHONE: 3oq S3d2 - 03 0 G (305) b"1 e -I/1 I (3o) t/Os-OS*6V f /hL2Dko( A.-01. Coin
Home I Work l Fax Email address
Business Name: SO,/-Ii, tit Ch NV Ise Aq r ffekt0.. ( n Position: AA ell in 1 s c.o. r
Address: Co Vot (0/&04/C 41f' Awl, ‘fa.d., Fl 33/3 '
No. Street City State Zip Code
, ��
Professional License (describe) N "it '/Y / NU K, el j 11 A0- M!p:c4/ 4+ qi3v /2 e 1 Z. Attach a copy of the license
Pursuant to City Code section 2 -22(4) a and b: Members of agencies, boards, and committees shall be affiliated with the city; this
requirement shall be fulfilled in the following ways: a) an individual shall have been a resident of the city for a minimum of six
months; or b) an individual shall demonstrate ownership /interest for a minimum of six months in a business established in the city.
• Resident of Miami Beach for a minimum of six (6) months: Yes : or No ❑
• Demonstrate an ownership /interest in a business in Miami Beach for a minimum of six (6) months: Yes N o ❑
• Are you a registered voter in Miami Beach: Yes J or No ❑
• (Please check one): I am now a resident of: North Beach ❑ South Beach ❑ Middle Beach
• I am applying for an appointment because I have special abilities, knowledge, experience. Please list below:
1 0.M, ght^l +h CA ft P•a ASS; o.al to .41, A." QX 4 - t ns.Vt. Sat.D( d in ! 4-"i
c &/f. 1 (toff 'tn-f 4t. 14fp'Sf e1lnrsin, Aa/• ;n M iprt, 44 A e I. �is .t - AM
4 Il /►'l : I i A / . to ) } 1 ) -Ore. e e, d S u# 44 A- 4 . 0.0/13 Pop * l A 3 i a n ,,-% 00 1 C o M .li o n, 1 1.
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that only three (3)
choices will be observed by the City Clerk's Office. (Regular Boards of City)
❑ Art in Public Places Committee ❑ Housing Authority*
❑ Beach Preservation Board ❑ Loan Review Committee* •
❑ Beautification Committee ❑Mayor's Green Ad -Hoc Committee ®# LlUe39
❑ Board of Adjustment* ❑ Marine Authority* _
❑ Budget Advisory Committee ❑ Miami Beach Cultural Arts Council
❑ Committee on Homeless ❑ Miami Beach Commission on Status of Women
❑ Committee for Quality Education in MB ❑ Miami Beach Florida Sister Cities
❑ Community Development Advisory* ❑ Normandy Shores Local Gov't Neigh. Improvement
❑ Community Relations Board ❑ Oversight Committee for General Obligation Bond
❑ Convention Center Advisory Board ❑'Parks and Recreation Facilities Board '
❑ Debarment Committee ❑ Personnel Board*
❑ Design Review Board* ❑ Planning Board*
❑ Disability Access Committee li ce Citizens Relations Committ-,-
❑ Fine Arts Board ❑ Production Industry Council
❑ Golf Advisory Committee ❑ Public Safety Advisory Committee
atflealth Advisory Committee ❑ Safety Committee
Fealth Facilities Authority Boar ❑ Transportation and Parking Copp-Meer) S, _ -11 j ; k 1 E3
❑ Hispanic Affairs Committee ❑ Visitor and Convention Authority*
❑ Historic Preservation Board* ❑ Youth Center Advisory Board OE :11 kid n �1S 0101
* Board Required to File State Disclosure form , 7'' '
1
I/
1
Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center:
1. Past service on the Youth Center Advisory Board: Yes ❑ No ❑ Years of Service:
2. Present participation in Youth Center activities by your children Yes❑ No O. If yes, please list the names of your children, their
ages, and which programs. List below:
Child's name: Age: Program:
Child's name: Age: Program:
•Have you ever been convicted of a felony: Yes ❑ or No ❑✓ryes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes ❑ or Noyes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes ❑ or No p4ryes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes ❑ or No elf yes; which board?
• What organizations in the City of Miami Beach do you currently hold membership in? N o n
Name: Title:
Name: Title:
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
Ow e - 3035 ? of l P, 1.1 '"
• I am now employed by the City of Miami Beach: Yes ❑ or No department?
• Pursuant to City Code Section 2 -25 (b): Do you have a parent ❑, spouse ❑, child ❑, brother ❑, or sister ❑ who is employed by the
City of Miami Beach? Check all that apply. Identify the department(s):
This section is "not required" but desired: Age: ,3 0 years old Gender: Male ❑ Female ai
Ethnic OrIgiRr(Check one)
White frican- American /Black ❑ Hispanic: ❑ Asian or Pacific Islander ❑ American Indian or Alaskan Native ❑
Employment Status: Employed fired ❑ Home -maker ❑ Other ❑
"I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article VII — of the City Code "Standards of Conduct for City Officers, Employees and Agency Members."
AA A/hi LI-6fr cache) Sc. h .t .s4 -e
Applicant's Signature Date Name of Applicant (PLEASE PRINT)
Please attach a copy of your resume to this application
NOTE: Applications will remain on file for a period of one (1) calendar year.
• Received in City Clerk's Office by MP % L �� c: Date c/o v
Name of Depu Clerk
Document Control Number (Assigned by the City Clerk's Office) Entered By . • Date
Revised 1/25/0710
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1 STATE OF FLORIDA:' AC# 3::3:;9 4 2 5 0
DEPARTME
DIVISION OF MEDICAL QUALITY. ASSURANCE `'s:a,;,;`';
DATE LICENSE NO. ttENTR0040.;..
0711612010 .: gt NH 4421 :'x::8843 :. : ::
The>..:: NURSING HOME ADMINISTRATOR -.
named below bas >met requirements of
the laws and rules of>ttie state of Florida
1 .. Expiration Date.,;:::;::;;:;. SEPTEMBER 30, 2012 ,::;, .;:..: : ....
RACHEL SCHUSTER • • LICENSEE SIGNATURE :..
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• • •
•
3035 Royal Palm Ave. Miami Beach, F1.33140 (305) 458 -3835 rschuster @hebrewhomes.org
Rachel Schuster
Objective
To utilize my education and experience in the field of health care administration.
Experience
2007- Present South Pointe Plaza Rehabilitation & Nursing Miami Beach, Fl
•
Center
Administrator
• Oversee, manage, and direct the day to day functions and overall operations of a 230
bed facility in accordance with the current federal, state, and local regulations that
govern long term care facilities.
• Lead facility staff in all aspect of facility operations, including setting priorities and job
assignments.
• Monitor each department's activities, communicate policies, evaluate performance,
provide feedback, and assist, observe, coach and discipline as needed.
• Maintain the highest degree of quality care for the resident while achieving the
facility's business objectives.
2003 -2007 Hebrew Home North Dade N. Miami Beach, Fl
Administrator
• Oversee and manage the operation of a 75 bed SNF
• Personnel and Human Resource Management
• Finance- billing and collections
• Marketing
• Physical resource management
• Resident Care
2002 -2003 Arch Plaza Nursing and Rehabilitation Center N. Miami, FI.
Administrator in Training
• Training centered on skill acquisition in prescribed areas of
administrative practice.
2000 -2002 Arch Plaza Nursing and Rehabilitation Center N. Miami, Fl.
Director of Admissions and Marketing
Responsible for census development for 98 bed SNF
• Pre - admission screening of prospective residents
• Determine Medicaid eligibility and apply for those eligible.
[Phone number]•[E -mail address]
[Your Name]
Education
2002 -2003 Florida International University Miami, Fl
Master of Public Administration
1998 -2001
Bachelor of Health Services Administration
Sum Cum Laude
Florida Licensed Nursing Home Administrator License # NH 4421
References
References are available on request.
• •
MIAMIBEACH
City of Miami Beach,
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachH.gov
Tel: 305.673.741 1 , Fax: 305.673.7254
Acknowledgement of fines /suspension for Board Members for failure
to comply with Miami -Dade County Financial Disclosure Code Provision
Code Section 2- 11.1(i) (2)
(k� Sc,
Board Member name:
I understand that no later than July 1, of each year all members of Boards and
Committees of the City of Miami Beach, including those of a purely advisory nature, are
required to comply with Miami -Dade County Disclosure Requirements. This means that the
members of City Advisory Boards, whose sole or primary responsibility is to recommend
legislation or give advice to the City Commission, must file, even though you may have been
recently appointed.
You must file one of the following with the City Clerk of Miami Beach, 1700 Convention
Center Drive, Miami Beach, Florida, by July 1 each year.
1. A "Source of Income Statement" (attached) or
2. A "Financial Statement" (attached( or]
3. A Copy of the person's current Federal Income Tax Return
Failure to file, according to the Miami -Dade County Code Chapter 1, General
Provision, Section 1 -5 may subject the person or firm to a fine not to exceed
$500.00 or by imprisonment in the county jail for a period not to exceed sixty
days, or both.
7(/l
(2 0
Signature: Date:
•
MIAMI•
COUNTY SOURCE OF INCOME STATEMENT
Please Print or Type First Name Middle Name /Initial Last Name
Disclosure
I ,j�, For Tax Year
Name: �^ {. ( N S I Ending:
of
Mailing Address: 3 n S g ti( r a' 1 Ave
City /State /Zip: /A U co I
Social Security Number:
Filing as a: ® County Employee:
® Municipal Employee of:
Position held or sought:
Board where serving :„7.I /I k (�-d V co / � /(04 Term or Employment
A I r Began on:
Department where employed:
U /j / 331 F(
Work Address: � I b/1(A S � I/`(. � l i !Ni I ') "r2e� �
If your home address is exempt from public records pursuant to 3 o s 7 )---1 7 7 /
Florida Statutes § 119.07 please check here (read instructions): ®Work Telephone: Attic( Home Address: (ti Q Q -S G O �� . 144A,1;4 rf
Street Address
City State Zip Code
Please list below in descending order with the largest source first, the name, address and
principal business activity of every source of your income including public salary you
received or any person received for your benefit or use during the disclosure period. The
income of your spouse or any business partner need not be disclosed. If continued on a
separate sheet, check here: •
Description of the Principal
Name of Source of Income /i Business Activity
.5�i•i 01,01.{ y(RZ, ` i /1 ✓A�� v1 ( j oi(/ (n ! /Y &l U I # Fcc, /i //
I hereby swear (or affirm) that the aforesaid information is a true and correct statement.
/c
Signature of person disclosing Date signed