Luis Bellmas - Baptist Outpatient Services WAMIBEACH BEAC e6Y\-‘ri
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage,defeat or
modification of any ordinance, resolution, action or decision of any commissioner, any action, decision, recommendation of the City
Manager or any city board or committee;or any action, decision or recommendation of any city personnel during the time period of the
entire decision-making process on such action, decision or recommendation that foreseeably will be heard or reviewed by the city
commission, or a city board or committee. The term specifically includes the principal as well as any employee engaged in lobbying
activities. The term "Lobbyists"has specific exclusions. Please refer to Ordinance 2004-3435.
Bellmas Luis
NAME OF LOBBYIST: (Last) (First) (M.l)
Baptist Outpatient Services 1500 San Remo Ave Coral Gables Florida 33146
BUSINESS NAME AND ADDRESS (Number and Stet) (City) (State) (Zip Code)
(786) 527-9404 LuisB @baptisthealth.net
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address, phone,or e-mail address.
I. LOBBYIST RETAINED BY:
Baptist Outpatient Services
NAME OF PRINCIPAUCLI:ENT:
Baptist Outpatient Services 1500 San Remo Ave Coral Gables FL 33143
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (rp Code)
(786)662-7353 PatriciR @baptisthealth.net
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)]
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY:
5 Gz■13 a c.i‘-- 4. •
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CQ,FgORATION,
PARTNERSHIP OR TRUST:
--i Gr1
e
ILSPE IFIC LOBBY ISSUE: 4-
. f`, -
Planning Board consideration of conditional use at 709 Alton Road, Miami Beach, FL --�
Issue to be lobbied(Describe in detail):
III.CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
(..)
Pursuant to City Code Section 2-482(a)(4)include the commissioner or personnel sought to be lobbied,and whether the Wbbyletas entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding which person's
commencement of service with the city to the present date stating the general nature of the subject contractual relationship.
Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to be lobbied ,
Planning Board X
Planning Department Staff X
Pursuant to City Code Section 2-482(g)Every registrant shall be required to slate the extent of any business,financial,familial or professional
relationship.or other relationship giving rise to an appearance of an impropriety.with any current city commissioner OT city personnel who is
sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2-482(g)Any Financial,Familial or Professional Relationship
NONE
C)W
LaRosa, Clara
From: AIan.Krischer @hklaw.com
Sent: Tuesday,January 27, 2015 2:45 PM
To: LaRosa, Clara
Subject: Baptist lobbyist registration
Importance: Low
Clara,
Per our discussions, the CEO of Baptist is Brian Keeley—and all of the entities are not-for-profit corporations except for
BHE, which is 100%owned by Baptist Health South Florida (which is a not-for-profit).
Alan
Alan Krischer I Holland&Knight
Partner
701 Brickell Avenue,Suite 3300 I Miami FL 33131
Phone 305.789.7758 I Fax 305.789.7799
alan.krischerPhklaw.com I www.hklaw.com
Add to address Bock I Mow protoss onalbiograpllyr
NOTE: This e-mail is from a law firm, Holland&Knight LLP ("H&K"), and is intended solely for the use of the individual(s)to whom it is
addressed. If you believe you received this e-mail in error, please notify the sender immediately, delete the e-mail from your computer and
do not copy or disclose it to anyone else. If you are not an existing client of H&K,do not construe anything in this e-mail to make you a client
unless it contains a specific statement to that effect and do not disclose anything to H&K in reply that you expect it to hold in confidence. If
you properly received this e-mail as a client, co-counsel or retained expert of H&K, you should maintain its contents in confidence in order to
preserve the attorney-client or work product privilege that may be available to protect confidentiality.
1
IV_ DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATCON(DISCLOSE WHETHER HOURLY,FLAT RA TE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required) $°
6) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $0
(Required).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-458 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Issues:
El Yes N No: Are you lobbying on a present or pending bid for goods,equipment or services,or on a present or pending
award for goods,equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues':
El Yes Eil No: Are you lobbying on a pending application for a Development Agreement with the City or application for
change of zoning map designation or change to the City's Future Land Use Map?
3) Pursuant to Miami Beach City Code 2-484(h)Any person(excerpt those exempt from the definition of lobbyist"as set forth in
Section 2-481 above) who only appears as a representative of a not-for-profit corporation or entity without special
compensation or reimbursement for the appearance, whether direct or indirect, to express support of or opposition to any
[ten,,shall register with the clerk as required by this section but,shall not be required to pay any registration fees.
El Yes DI No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement _
V_ SIGNATURE UNDER OATH:
ON FEBRUARY 28th OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES,AS WELL AS COMPENSATION RECEIVED,IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
r itvtiele,,c2_________
Xi� re of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach City Code a, all reporting requirements.
711;Signature of Lobbyist:
-40' ejge_____
Signature of PrincipallC6ent. Or
VI_ LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
El Produced ID ® Produced ID
Form of Identification Form of Identification
El Personally known(Lobbyist) Personally known(Principal)
VII_ SIGNATURE AND STAMP OF NOTARY:
State of Florida,County-of Miami-Dade State of Florida, County of Miami-Dade
Sworn to and subscribed,before me Sworn and subscribe before me
This I:
f '
(a day of„x111 .-2011 20 i 5 This Z(e day of Ott..0an+�,2. &*S________._.____,
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MY CoM�ssloN I+FF 1
..,,, . ARLEEN vaEz 1 // e
s-, of Pub'rNotary—State,o r 1 = EXPIRES:September 19,2018 a mature of Publcc ary—State of i
otarizadon o"1 ,b fist's signat ��f�t`';: Bonded „Noisy POW
tarization of ncipal's signat �'W” Ni, AMENVBFZ
cif;i ,•, :4 MY COMMISSION 9 FF 148018
"—;— ..--4�:. EXPIRES:September 19,2018
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY . � � miters
Annual Registration fee: I Yes I1 1 No Amount Paid$ gdU ti1CR# L f Q/ Ya 1 Date •
Lobbyist Registration Form received and verified by: /
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F.1. i LLIaFt 1,11 SM "FORMS>i Lobbyist Ed g a {,, dx
Revised 1/1 12011
MIAMtEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miiambeachfl.gov
CITY CLERK Office C IyC#erk@micrnibeachfl_gov
Tel:305.6737411 ,Fax:305.673.7254
LOBBYIST NAME: Luis Bellmas
I understand that no later than February 28th of each year, I must file the following form, pursuant
to Section 2-485 of the Miami Beach City Code, with the City Clerk's Office for all active lobbying
issues.
1) Lobbyist Expenditure and Compensation Form
Failure to file these forms on a timely basis will result in my name being transmitted to the Miami-Dade
County Commission on Ethics and for code violation evaluation.
In addition, once an issue I have registered to lobby on has been resolved, I am required to
immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
VaL//5
ignature: Date:
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City of Miami Beach-Florida
Finance Department
1 City Hall
150713-1 01/27/2015 BR1 T121
•l ue !an27,2015 03:17PM Trans#82-d2
82 $850.00 MCRCLERK - MCR-City Clerk
x MCR#: 401427
1 ITEM(S). TOTAL: $850.00
Check (305347) PAID $850.00
Have a nice day!
. •
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CITY OF MIAMI
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