Sundeep Arora - Baptist Health South Florida, Inc .MIAMI- BEAC : H
r „: _'
City of Miami Beach
1700 Convention Center Drive 2g 15 FEB 20 P 2: 5S
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: Sundeep Arora
Business Name: BAPTIST HEALTH SOUTH FLORIDA
Address: 6855 Red Road, Coral Gables, Florida, 33143
Office Telephone Number: (786) 662-7761
. Cellular Telephone Number:
Email Address: SundeepA @baptisthealth.net
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#: 90/ire9V
Amount paid: e-_7% G Date P aid:
Processed by by. 4111, 1,0Z i ( Date: 0 /c"
FNCAERR#ARL4.FORMS11 OE,E•l ST FORMEW€NUAL LOBBYIST REGISTRATION FORM meg:dxcx
AM I BEAC H
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_
Arora Sundeep
NAME OF LOBBYIST: (Last) (First) (M.I)
Baptist Health South Florida 6855 Red Road Coral Gables Florida 33146
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786) 662-7761 SundeepA @baptisthealth.net
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone,or e-mail address.
l_ LOBBYIST RETAINED BY:
Baptist Health South Florida, Inc
NAME OF PRINCIPAUCLIENT: Ved
Baptist Health South Florida,Inc 6855 geed Road,Suite 500 Coral Gables FL 33143
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786)662-7761
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:
C) PV
• IDENTIFY ALL PERSONS HOLDING.DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH t1RPOR'�1`TION,
PARTNERSHIP OR TRUST: rr;
C
i -
Ii.SPECIFIC LOBBY ISSUE: ° c
Planning Board consideration of conditional use at 709 Alton Road, Miami Beach, FL
Issue to be lobbied(Describe in detail): 'I• r‘)
-�! s•
lu.CITY AGENCIESAINDIVIDUALS TO BE LOBBIED:
0-,
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 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 filed
Sec 2-482(g)Any Financial,Familial or Professional Relationship
NONE
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY.FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE.:(Required) $°
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $0
(Required).
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":
® 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":
❑Yes Dil 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(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.
0 Yes NJ 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.
4,:._
Signarr o Lo st
I do solemnly swear that all of the foregoing facts are , _e and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach C ' Code and all -e•rting requirements.
Signature of Lobbyist: V .
;.�� ∎`�. __,!-,\
Signature of Principal/Client:
• ,fik .4 IllY .1.1i
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: A CO e
A m = g N N•O H . - m=
® Produced ID O N N ® Produced ID .c c N IN i
Form of Identificatio < . N N i Form of Identification a "^ a
LK'Persona known(Lobbyist) . °M Persona known Principal ° `, s+ w
saW a od E E
VII SIGNATURE AND STAMP OF NO,TA'113 Z E A v i .
. a
State of Florida,County of Miami-Dade 11131 State of Florida,County of Miami-Dade „g,,,Sworn to d subscribed b-fore me Sworn subs efore me ;.•`��...'';�.
Thi day of ���: .2015 •. Thisl� of � .2D�5' gds�`._,��-?•• ) 41' \ i e40/41%. 1 Signal±of Public Notary ! tate of Florida A'•;ia ,,,`-/ , Signa `of Public Notary—S to of Florida
Notarization of Lobbyist's signature -: Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: r� Yes r l No Amount Paid . d�Ct # C/®/%tt t1 Date Paid /�
Lobbyist Registration Form received and verified by: 4ri.. 0 —,-Atl l�l t
Mutual ; do l=�n doe Revised 1/11/2011
�:tia���, �a�O �t_o�t;Y�r�Dpq ,�t .ls�
• WI, h B EAC H
City of Miami Beach, 1700 Convention Center Drive,Miami Bench,Florida 33139,www.miamibeachfl.gov
CITY CLERK Office CityCferk @miarnibeachf1.gov
Tel:305.6737411 ,Fax:305.673.7254
LOBBYIST NAME: Sundeep Arora
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.
a ti //S
Signatur : ate:
•
1
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
Acid to addr,.;t.;�ic ii^w:jr. _sirs;I'iT�•-i,ni
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
Afisi.t acidre` i ii:i `r't>.;uro es,iona!hi,:rriw.h•r'
1
IOLLAND&KNIGHT LLP 1046428 City of Miami Beach 02/17/15 CHECK NO. 305406
VOUCHER INVOICE INVOICE DATE DESCRIPTION AMOUNT
2790895 139314 02/17/15 7 Annual and Issue Lobbyist Registration for City of $850.00 ,
•
St)i\g-gef r2.02_
-
i
TOTAL $850.00
HOLLAND & KNIGHT LLP BANK OF AMERICA 63 4/630 30 305406
701 BRICKELL AVENUE,SUITE 3000 VOID AFTER 180 DAYS U.S.FUNDS
MIAMI,FL 33131
(813)901-4415
DATE AMOUNT
02/17/15 $850.00
A EIGHT HUNDRED FIFTY AND 00/100
Y
TO THE City of Miami Beach TWO SIGNATURES REQUIRED ON CHECKS OVER$5,000
ORDER
OF
50 f\ ef),
11. 3051106v u:06300004 ?u:8980356 L L9 770
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