Joseph G. Goldstein - Baptist Health South Florida, Inc. City of Miami Beach 21 FEB 1700 Convention Center Drive `� F 1
Miami Beach, Florida 33139 , I nit
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ww.miamibeachfl.gov � + �' `r'°
City Clerk's Office
Tel: 305-673-7411
Fax: 305-673-7254 Office Use Only
ANNUAL LOBBYIST REGISTRATION FORM
Name: JOSEPH G. GOLDSTEIN
Business Name: HOLLAND & KNIGHT LLP
Address: 701 Brickell Ave., Suite 3300, Miami, FL 33131
Office Telephone Number: (305) 374-8500
Cellular Telephone Number: (954) 648-8143
Email Address: joseph.goldstein @hklaw.com
If more than one lobbyist,please list:
1)
2)
3)
4)
5)
6)
7)
Submit this form to the Office of the City Clerk, along with a check for $500 for each
lobbyist. Please make the check(s) payable to the City of Miami Beach.
For City Clerk's Office Use Only
MCR #: Lfbl 0;95
Amount paid: 85T)g Date paid: at' IS
Processed by: c - SOIVC.-tal Date: alDo 15'
F:ICLER\SALL1aFORMS\LOBBYIST FORMSWNNUAL LOBBYIST REGISTRATION FORM reg.docx
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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.
GOLDSTEIN JOSEPH G.
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)789-7782 (305)679-6313 jjoseph.goldstein @hklaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL: c
Please notify this office if your contact information changes:address,phone, or e-mail address.' —7-, •
iy
I. LOBBYIST RETAINED BY:
CD
BAPTIST HEALTH SOUTH FLORIDA,INC. ,
NAME OF PRINCIPAUCLIENT: '73 --
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
.rt
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) C5
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] ,
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY:
Ste. �C� ..�-
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
ILSPECIFIC LOBBY:ISSUE:.
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 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\$ALL\aFORMS\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)
5655/hr.
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED).$655/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":
_Yesr7lo: 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": .
—Yeo: 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.
_YeF,: 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 FILED/EVEN IF THE- HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
'il j'1,--/.411/,-. .?"--
Signature 7obb Z
I do solemnly swear that all of the foregoi acts -.- true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach oo.- all reporting requirements.
Signature of Lobbyist: , 4. __
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identification
Personally known(Lobbyist) Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County .f i. .-I-•e State of Florida, County of Miami-Dade
Sworn to and subscribe. rn��.gt rie TIA41nLUAMS ; Sworn and subscribed before me
This 17th day of Fe'r'�F'',1, 2QVkCOMMISSION#EE 85800 ; This day of , 201
-)-'''L-- . / ,ill, �
^:,_��, EXPIRES:June 15,2015 :
!.. ``,,�,l d:•` Bonded True Notary Public UndenMiters i
Signature of Public Not- , . - • - Signature of Public Notary-State of Florida
Notarization of Lobbyist's signature Notarization of Principal's,signature
TO BE COMPLET.D BY CITY CLERK'S STAFF ONLY
Annual Registration fee: Yes[ ]No Amount Paid$ a k Li-
ili ■C- # 4' Date Paid
---AW3-7
Lobbyist Registration Form received and verified by !M'-` T_._Rt:_. .
F:\CLER\ ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Regi 'ton' n c Revised 01/22/2014
F:\CLER\$ALL\aFORMS\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)
$655/hr.
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED).u55 ,.
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": •
Ye7o: 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.
Yes V ): 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 FILED/EVEN IF THER HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD. --"' "
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Signature oftobb . -'
I do solemnly swear that all of the foregoilactsap true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach;ity9b.-.5ariciall reporting requirements.
//C:''
Signature of Lobbyist:
.„, ',;,-Y.Signature of Principal/Client:
ka A
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID—
Form of Identification Form of Identification
�, N�n
I/
Personally known(Lobbyist) Zrsonally known(Principal)
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VII. SIGNATURE AND STAMP OF NOTARY: i g 2
to f2 •
State of Florida,County of Miami:Cale ________ _ _ _ State of Florida, County of Miami-Dade c u
;
Sworn to and subscribe. oa 4 ,me , Sworn subscr•-• +efore me cc a W
.�'�•. TIA WI WAMS > >
This 17th day of Fe; � .�, { 24P—COMMISSION#EE 85800 ' T is 19 a of el•• , 201E o- E ,•c.".,�,.---'':: j ,t.,:2:.r' EXPIRES:June 15,2015 r X�° E
.l_... •�.,?....t,.• Bonded TM Notary Public Underwraers I,S. ` ! wt . .h, :i.l 21
Signature of Public Not- a 61 – Sign ffit. of Public No ary– i ate of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature / 'o
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY t'1'��'-1�$
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid ' t
Lobbyist Registration Form received and verified by: ''"""'
F:\CLER!$ALL!aFORMSIL0bBYIST FORMS Lobbyist Annual Registration Form.dor. Revised 01/2 .. '
F:\CLER\$ALL1aFORMS\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: JOSEPH G. GOLDSTEIN
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-fe'om lobbying until all fines are paid, unless the fine has been
�j
appealed to the Miami=D de County;Commission on Ethics and Public Trust.
„%-- - - 7715 •
Signature: / �" Date:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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
Phone 305.789.7758 I Fax 305.789.7799
alan.krischer@hklaw.com I www.hklaw.com
Add_to�ids�s�t.__k;:ii^i•{�rn`c�;,�t?r•�I bi^gr;a�>^_.x
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
.........................................................................................................................................
Add!c:a:;i�'f's[:.;;_;� !'•f.,nrn;`eisiont:�t>ie;;rr:a4 liy
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HOLLAND&KNIGHT LLP 1046428 City of Miami Beach 02/18/15 CHECK NO. 305413
VOUCHER INVOICE INVOICE DATE DESCRIPTION AMOUNT
2791518 139345 p2/18/15 Annual and Issue Lobbyist Registration Fee for Sun $850.00
•
TOTAL $850.00
HOLLAND & KNIGHT LLP BANK OF AMERICA 63-4/630 30 305413
701 BRICKELL AVENUE,SUITE 3000 VOID AFTER 180 DAYS U.S.FUNDS
MIAMI,FL 33131
(813)901-4415
DATE AMOUNT
02/18/15 $850.00
A EIGHT HUNDRED FIFTY AND 00/100
Y
TWO SIGNATURES REQUIRED • CHECKS OVER$5,000
TO THE City of Miami Beach
ORDER - n
OF
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II■ 30541311' 1:06300001. 71:89803561 L977116
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