George Foyo - Baptist Health South Florida, Inc •
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City of Miami Beach °ace of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION!FORM
!Lobbyist means all persons e;m,ployecl or,retained, whether paid or not, by a principal who seeks to encourage the passage, defeat o.r
modification of any ordinance, resoludo:n, action or decision of any commissioner; any action, decision, recommendation of the City
Manager or any city board or 00:mm1:ee; 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 reoonmrtmendation that fareseeably+ will be heard or reviewed by the city
commission, or a city beard or committee. The term specifically includes the principal as well as any employee engaged en lobbying
activities.. The term Lobbyists"has specific exclusions. Please refer to'Ordinance 2004-3435_
Foyo George
NAME OF LOBBYIST: (Last) (First) 4:149.11
Baptist Health South Florida 6855 Red Road Coral Gables Florida 33146
BUSINESS NAME AND ADDRESS (Wilber and Street) (City) (State) (Zip Code)
(786) 662-7212 BrianK @baptisthealth.net
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
.Please norm this office if your C011iracr information changes:address, phone, or e-mail address.
LOBBYIST RETAINED BY:
Baptist Health South Florida, Inc.
NAME OF?.RIN C IPAL1CLIENT:
Baptist Health South Florida,Inc 6855 Read Road,Suite 500 Coral Gables • FL 33143
BUSINESS NAME AND ADDRESS (Number and Street) (City) (Stare) (Zip Code)
(786)662-7401 dg the @baptisthealth.net
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
—t cr
Fill out this Sectian if principal is a Corporation,Partnership or Trust pSe Lion 2-482(c)]
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NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY:
= N =
• IDI NTIFY.A:LL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5°e OR MORE OWNERSHIP INTEREST:IN SU pI COI-PORATION,
PARTNERSHIP OR TRUST: - a
ILSPECIFIC LOBBY ISSUE: --
Planning Board consideration of conditional use at 709 Alton Road, Miami Beach, FL
Issue to be lobbied(Descd e irg
Ill_CITY AG;ENCIESflNDWIDUA.LS TO BE LOBBIED:
'Pursuant to City Code Section 2-4820314)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 persons
commencement of service with the city to the present date,stating the general nature of the subject contractual relationship.
Sec 2-4-B2 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
N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISC'LO aE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required) $0
B) PRINCIPAL'S DISCLOSURE OF LOBBYIST COMPENSATION): $0
,[Required.
The following information must be answered:
1) Pursuant to M!ia.mi Teach City Code Section 2-488 Entitled:°Prohibited Ca.mpaig i Contribuiio.ns.By Lobbyists On Procurement
Issues":
0 Yes _K No: Are you IobbvirbR_on.a present_or pending bid for goods..equipment or services..or on a present or pending
awar=d for flood. equipment service?
2) Pursuant to Miami Beach City Code 2-9C0 Entitled Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues':
0 Yes Dil No: Are vo ui lob Wino on a pending application for a Development Anreement with the City or aooiication for
chance of zoninn ma all,diesianation or chance to the City's.Future Land Use M:ap?
: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 representadva of a not-for-profit corporation or entity without special
compensation or reimbursement for the appearanoe, 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. j o: Are you representing a not-for-profile corporation or entity without special compensation or reimbursement_ _
V. SIGNATURE UNDER OATH:
0M 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.. Ii. THE CITY OF MIAMI BEACH FOR
THE PRECEDING'CALENDAR YEAR._ A STATEMENT SHALL BE FILED EVEN IF THER- AVE BEEN NO EXPENDITURES OR
COMP'FNSATION]DURING THE REPORTING PERIOD_
Signature cbb►ist
I do solemnly swear that all of the foregoing facts are true and c•- -ct and that II have ad or am familiar's ith the provisions contained
in Section 2482 of the Miami Beach City Code a,...:., all rrepo:rb 1 requirements.
Signature of Lobbyist: w %L.1�`‘i
. 1141 110/7 ' i
Signa�ure of F'ri.ncipab'Cfien#: �,�_ ':§ (N-2 .-
o a
V
a5e°v ° s
VI_ LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: N z
R .. -4 = 7..
0 Produced ID i N O 0 .Produced ID W 6.1 is o z
'Form of Identifica ion % s N N g Form.of Identification c E E
o g ' -
Personally.known 1Lobbyist� W°� Personal:ly known('Principal) o $
I p ,� ;to
VII_ SIGNATURE AND STAMP OF NOTARY:I = =W - ' ,".c.oo,,,
State of Florida,County vt Miami-Dade (. m State of Florida,County of Miami-Dade 4' = 1��c
Sworn to an subscribe c. me Sworn and subscribed b fore me y�4 °/1.�s�*��
go�oaq°
Th is day of • .' '&1-1-�ex%6-4 �� ►"a, This y of . .` -1-4-� . - -
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Sigmas - of Public Notary Sta of Fonda y�,`1;.�;�.' Sign.at , of Public Notary-S. to of Florida
Notarization of Lobbyist's signature , a"'01'��� Notarization of Principal's signature
•
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fie: 11'Yes f 1 No Amount''Pa-' S•g SO •pO AR# (I 0,/4)3 9 Date Paid 211 Z12.0/�
Lobbyist Registration Form received and irerifled by: .. i2 k 1
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F:1�CLERI$ALU(.2FORMSI:LOBBYIST FGRilS)Lobbrist.1121 nua.R tl� artuud.3C Revised 1/11/2011
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City al Miami'rt3eO& 700 Ccm2ntion Ce-n.tr Drive,Miorni Beach, Florida 33134,voww.rniam'rbeocnf gav
Cliff'C0.51K Oise CilyCkerkt micmibeach 1.-9oi
305,673.7411 .Fat:305.+673.7254
LOBBYIST NAME George Foyo
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 ca timely basis will result in my name being transmitted to the Miami'Dade
County Commission on Ethics and for code violation valuation_
In addition, once on issue I have registered to lobby •on has been resolved, I am required to •
immediately notify the City Clerk's Office lobbyist withdrawal in writing.
Signature: • Date:
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City of Miami Beach-Florida
Finance Department
1 City Hall
1504320-1 122015 02/12/2015 0 :21PM T BR1 T114
Thu Feb , 2rans#5-5
5 $850.00 MCRCLERK - MCR-City Clerk
* MCR#: 401489
1 ITEM(S): TOTAL: $850.00
Check (305399) PAID $850.00
Have a nice day!
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