Jose C. Romano - Baptist Health South Florida, Inc. \ar\ Vi
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City of Miami Beach Office of the City Clerk
17000 Convention, Center Drive, Miami Beach, FL 3313g-
LOBBYIST REGISTRATION FORM 2015 APR -7 NI 1: 54
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. resotutior, action or decision of any commissioner; any action, d c1simri;;;ireco\rnmendatipri_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 decisiori-making process on such action, decision or recommendation that foreseeab(y 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 IIobbYing
activities. The term `Lobbyists"has specific exclusion.s. Please refer to Ordinance 20044435
Romano Jose C.
NAME OF LOBBYIST: (Last) (First) (M.l)
Baptist Health South Florida 6855 Red Road Coral Gables Florida 33146
BUSINESS NAME AND ADDRESS (Number and Street') (City) (State) (Zip Code)
(786) 467-5420 JoseRom @baptisthealth.net
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
,lease notiiy'this Office if your .contact informat on chances
.,� . �. :aarcireSs,phone, or e-mall address.
I LOBBYIST RETAINED BY: •
Baptist Health South Florida, Inc
• NAME,OF PRINCIPA CLIENT:
Baptist Health South Florida,Inc 6855 Read Road,Suite 500 Coral Gables FL 33143
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786)662-7401 GeorgeFo @baptisthealth.net
TELEPHONE NUMBER:: FAX NUMBER:(Optional), EMAIL:(Optional)
Fit out this section if principal is.a Corporation.Partnership or Trust[Section 2-482(c)]
• NAME OF CHIEF OFFICER,PARTNER.,OR BENEFICIARY: „mot
• IDENTIFY ALL PERSONS HOLDINO.DI.RE:CTL.Y'OR INDIRECTLY„A.5%.OR MORE OWNERSHIP'INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
IIIF87PECIFIC LOBBY'ISSUE�
Planning Board consideration of conditional use at 709 Alton Road, Miami Beach, FL
'Issue to be lobbied pesorbe detail):
all biti'AGENrCIES. INbi it U LS TO B'E L�OBBIEI
Pursuant:to City Code Section 2-4820)(4)include the commissioner or personnel sought to be lobbied,and whether the lobbyist has entered
into any contractual relationship (paid or unpaid),with said city commissioner or personnel from 12 months preceding such 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(`Dame of Individu.al 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 state 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 or city personnel who is'
sought to be lobbied as identified on the lobbyist.registration form filedl.
Sec 2-482(g)Any Financial,Familial or Professional Relationship
NONE
14f_ DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATCON(DISCLOSE WHETHER HOURLY FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE.:(Rewired) $0 .
8) PRINCIPAL'S DISCLOSURE.(OF LOBBYIST COMPENSATION): $0
(Required).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Ended'Pcah2bited Campaign Contributions By Lobbyists On Procurement
Issues
Yes N:No: Are you lob yino on a present or pending bid:for goods,equipment or services;or on a present or pending
award for groods•,equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled-Prohibited Campaign Contributions By Lobbyists On Rea Estate
Development Issues':
0 Yes g No: Are you:lobbying on a pendirro application for a Development Aoreement.with the City or application for
change of zoning map.designation or c'hanoet to the City's Future Land Use Map?
3) Pursuant to Miami Beacom City Code 2-484(h).Any person(except those exempt from the definition of lobbyist as set forth in
Section 2-481 above) who o;nFy 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
item,shall register with the clerk as required; this section but,shall not be required to pay any registration fees.
0 Yes 1 No: Are you representing a not-far-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 SHAD BE FILED EV, N IF THERE HAVE BEEN NO EXPENDITURES OR
'COMPENSATION DURING THE REPORTING PERIOD. "/
AV A ALI A •
Sign., •f,rbbyi"
I do solemnly swear that all, the foregoing facts are true correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Mia I Beach C- C and all repo requirements.
Signature of Lobbyist: (A / ,
Signature of PrincipallClien.. .I V a �G,(to ty CUN' A
VI_ LOBBYIST IDE IFICATIO,N: PRINCIPAL IDENTIFICATION:
OD d
a
0 Produced ID, s N c 0 Produced ID 2
Form of Identification S N a g. form of Identification , $j N 1
.-
Persona known(Lobbyist) = 2/Personally known(Principal) W •
VII_ SIGNATURE AND STAMP OF NOTARY: ® ". a ' '
Jam' ,-
State of Florida,County of Miami-Dade $ c E°a State of Florida,County of Miami-Dade
Sworn to a subscribed before me z am and subscribed before me If •
This .. .1\day of 111_.A.... _. ,201`INE-- a.. his3I arday of lyarch .20'15'
\1AM m
„
a %
Signatu - i Public Notary—S -14- of Florida lj 4 i Si 'tore of Public.r+ll6tary—State of Florida ,c :
'Notarization of Lobbyist's signature %y..i;..;„..... M -tarization of Principal's signature
TO BE COMPLETED BY CITY CLERICS STAFF ON:LY
Annual Registration fee ■ Yes( 1�1a ;'Amount Paid$ BSo • iLICR#4o dZZ,'-ID.'-/Z3 Date Paid Oyw7' 2oIs-
Lobbyist Registration F. ► .ivied and verified try_ I'S” r6goe.e
��,
),Q-ER vla1:'iiantuviviian5'tirst'mRi ALtalbtrytsrl Atirruat Om,Foaar. e ; '. Revised 1/11,12011
MAME.ACH
ally a Miami Beach,,1700 Convenhon.Ceraer Drive,Miami Beach,Florida 33139,www_nnEarn1beachfl;Bov
CITY CLERK€tfice C-IyCierk @miamibeachlgov
Tel:305.67314 111 ,.Fax:305.073.7254
LOBBYIST NAME:
Jose C. Romano
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.
1 4 0351/1.5-
5ignatur:: te:
•
•
Williams, Tia D (MIA - X27461)
From: Krischer, Alan S (MIA - X27758)
Sent: Wednesday, February 18, 2015 11:42 AM
To: Williams, Tia D (MIA - X27461)
Subject: FW: Baptist lobbyist registration
Alan Krischer I Holland&Knight
Partner
701 Brickell Avenue,Suite 3300 I Miami FL 33131 1
Phone 305.789.7758 I Fax 305.789.7799
alan.krischer @hklaw.com I www.hklaw.com
Atid o adiircrss b�k!View pro°ss_o r.;i!bioy;raoirp
From: Krischer, Alan S (MIA-X27758)
Sent:Tuesday,January 27, 2015 2:45 PM
To: 'claralarosa @miamibeachfl.gov'
Subject: Baptist lobbyist registration
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.krischer@hklaw.com I www.hklaw.com
1
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