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Alan S. Krischer - Baptist Health South Florida, Inc. I 1 £ A i? City of Miami Beach 1700 Convention Center Drive Miami Beach, Florida 33139 www.miamibeachfl.gov City Clerk's Office Tel: 305-673-7411 Fax: 305-673-7254 Office Use Only ANNUAL LOBBYIST REGISTRATION FORM Name: ALAN S. KRISCHER Business Name: HOLLAND & 'KNIGHT LLP Address: 701 Brickell Ave., Suite 3300, Miami, FL 33131 Office Telephone Number: (305) 374-8500 Cellular Telephone Number: (305) 496-1602 Email Address: alan.krischer@hklaw.com If more than one lobbyist,please list: 1) • 2) 3) 4) - ( ) 5) 7) Submit this form to the Office of the City Clerk, along with a check for $500 for each ,S lobbyist. Please make the check(s) payable to the City of Miami Beach. For City Clerk's Office Use Only MCR#: q1,/y3'Z. 0'9 ° Amount paid: S LCD Date paid: 1 7 /J Processed by: C/49.„ Date: //..)-7//r F:ICLER\SALL1aFORMS\LOBBYIST FORMS\ANNUAL LOBBYIST REGISTRATION FORM reg.docx ' t s Al I} % z Wiz;, t 3 3f s, i b sy < Ai, �L F� ?,s ?' I. F f.:r ER:...,�s ur. G g, s�". 4: 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. KRISCHER ALAN • S. NAME OF LOBBYIST: (Last) (First) (M.I) HOLLAND&KNIGHT LLP 701 Brickell Ave.,Suite 3300 Miami FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)789-7758 (305)679-6379 alan.krischer@hklaw.com 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 HEALTH SOUTH FLORIDA,INC. NAME OF PRINCIPAL/CLIENT: BAPTIST HEALTH SOUTH FLORIDA,INC. 6855 Red Road,Suite 600 Coral Gables FL 33143 BUSINESS NAME AND ADDRESS (Number and Street) (City) • (State) (Zip Code) • (786)662-7272 TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] ~ ` -1^:4 • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: 2 . • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORRORATION, PARTNERSHIP OR TRUST: ii.SPECIFIC LOBBY ISSUE: —7' _t Planning Board consideration of conditional use at 709 Alton Road,Miami Beach,FL CA) Issue to be lobbied(Describe in detail): — CD �. Ill.CITY AGENCIES/INDIVIDUALS TO. BE LOBBIED: 103 Pursuant to City Code Section 2-482(a)(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 Name of Individual and Contractual Relationship(Explain) YES NO title of person to be lobbied Planning Board X Planning Dept. 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 filed. Sec 2-482(g)Any Financial,Familial or Professional Relationship None - F:\CLER\$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $525/hr B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED).$525/hr. The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues": _Yesno: 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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yejo: 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 Section 2-482(h)Any person (except 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 item, shall register with the clerk as required by this section but, shall not be required to pay any registration fees. _YeJ: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON FEBRUARY 28 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 Fl a EVENIg-T-HERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. 410Y1111117:- Sign.-• e of Lobbyist I do solemnly swear that all of the foregoin is are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Bea C• e a • =i+=porting requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID F� �vet? 's Form of Identification Form of Identification . ttJ `O �I V' y r Personally known(Lobbyist) Personally known(Principal) i o (.„ZP. s• .y Q CO = ; VII. SIGNATURE AND STAMP OF NOTARY: y " W ■ ifk 'O nj C �r State of Florida, County o Mia -ii Dade _ State of Florida, County of Miami-Dade. Q `" ti j;-' Sworn to and subscribed •et, ern a d subscnb d before me - r This da. of 'p 01 TIAWIWAMS y. 21st J-nu-..?S' k- •- 4-A� . 201 X � _�� %e�, se? �LCOMMISSION A EE 85800 � - � Y � r n �� V . I �:,.,��,,: EXPIRES:June 15,2015 l \ !' l� .�;.: Bonded Thru Notary Public Undeiwntero i Ct� v ,,,,,,,,11,, m° Signature of Public Nota ' = " - -• ' • •- Signat're of Publ. votary—State of Florida ;Q)°`.*• b�•: Notarization of Lobbyist's signature Notari ation of p'rincipal's signature � ��`;� = TO BE COMPLETED B ITY CLER STAFF ONLY St; Annual Registration fee: [ Yes[ ]No Amount Paid$ MCR# D 2. Date Paid R: �h_. Jl Lobbyist Registration Form received and verified by: \CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Forrn.doc Revised 01/22/2014 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov Tel: 305.673.741 1 , Fax:305.673.7254 LOBBYIST NAME: ALAN S. KRISCHER I understand that no later than February 28 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, or I am no longer lobbying on that issue or for that principal, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. Pursuant to Section 2-485 (d), the City Clerk shall notify any lobbyist(or principal) who fails to timely file a Statement and in addition to any other penalties which may be imposed as provided in Section 2-485.1, a fine of$50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, who fails to file the required Statement by April 30th of each year, shall be automatically suspended from lobbying until all fines are paid, unless the fine has been appealed to the Mia. i-Dade County Commission on Ethics and Public Trust. • Si 41.rt. e: Date: • F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc LaRosa, Clara From: Alan.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.krischer@hklaw.com l www.hklaw.com Add to aaaress book j yi wpreossional bio ta}thy 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 aExq=-,c•n+u:'-+:.N.r. Yl•_'fs'al'-,-� --r..a ..rah_ -.... a City of Miami Beach-Florida Finance Department Litt' Hail 5021 r'13-1 01/27/2015 BR1 T121 we Jan27 1015 '3 7 P i I and# �3-78 78 $850,00 MC-CLERK - MCR-City Clerk * NCR#: 401432 1 ITEMS): TOTAL: $850.00 Check (305330) PAID $350.00 Check i 305331) PAID $500.00 Have a nice day! 33_ f ��yqq ■:. 7 s�E; 4)/2 f�2fil5 00I ;t2-1 Miscellaneous Cash Receipt CITY OF MIAMI BEACH : e P ` .. . . Wit• � ❑ Cash ' El Credit Card :c Check::#' = - • Received of !/'&f ! Address -7 ! �' -}' t 4 `J Far ;��:.. �.. —� � _ •' ;. • r 1 (THIS INFORMATION MUST BE COMPLETED Office of Finance Direct®r ' r � Account Number. :- Preparer: Dept: