Bernie Fernandez, Jr. - Baptist Health Medical Group M I AAA I B _AC H
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33130
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.
Fernandez Bernie
NAME OF LOBBYIST: (Last) (First) (M.I)
Baptist Health Medical Group 1500 San Remo Ave Miami Florida 33146
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786) 527-9205 BernieF @baptisthealth.net
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 Medical Group
NAME OF PRINCIPALJCLIENIi:
Baptist Health Medical Group 1500 San Remo Ave Coral Gables FL 33146
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (gyp Code)
(786)527-9205 BernieF @baptisthealth.net
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 '.
▪ IDENTIFY ALL PERSONS HOLDING.DIRECTLY OR'INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPaliAT1ON0,
PARTNERSHIP OR TRUST:
ILSPECIFIC LOBBY ISSUE: -.
T .e
Planning Board consideration of conditional use at 709 Alton Road, Miami Beach, FL
Issue to be lobbied(Describe is detaa):
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 eneral 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
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@jhklaw.com I www.hklaw.com
Add to address book View professional b onra h
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
140. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATIAN(DISCLOSE WHETHER HOURLY.FLAT RA TE 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 Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Issues":
® Yes Di 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"Prohbited Campaign Contributions By Lobbyists On Real Estate
Development Issues':
El Yes 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 Cr 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 EXI 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. I:
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach City Code and I orting requirements.
Signature of Lobbyist:
Signature of Principal C5ent:
VL LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
® Produced ID ® Produced ID
Form of Identification Form of Identification
Personally known(Lobbyist ■ Personally known(Principal)
VII_ SIGNATURE AND STAMP Or t4O1¢1 w
.. f :
S'pr
o',
.` � MARYANN PATRICIA ZALDIVAR
State of Florida,County of Miami-Dade '. ` * MY COMMISSION#FF112959 State of Florida,County of Miami-Dade
Sworn to and subscribed before me Swo and subscribed before me
This R.,L' j -day of 011 'p , fir'' EXPIRES April 15,2018 This €ayr of I 1
(407)398-0153 FloridallotaryService.com /
•Signature o ublic Nola State of Florida Signature of P lie Notary—Se- of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
TO IRE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: r Yes r 1 No Amount Paid$ , g# MCR.f plyLiSh Date Paid 1'7 4''
Lobbyist Registration Form received and verified by: C a..... La,
F.2 ERl tiILjlg ORNISI,LQZ r FOI,' \I! 1 tAnnual. 8cnr'F Revised 1/1.11201.1
• MIAMBEACH
...._
City of Miami Beach, i 700 Convention Cen1?r Drive,Miami Beach,Florida 33139,www_miarnibeathfl.gov
CITY ClERK Office CityCferk@miarnibeachfl_gov
Tel:305.673?411 ,Fax:305.673.7254
LOBBYIST NAME: Bernie Fernandez, Jr., M.D•
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.liZ3 \ IS'
Signature: ate:
!
3T�-
City of Miami Beach-Florida
Finance Department
1 City Hall
1502713-1 01/27/2015 6R1 T121
Tut Jan27,2015 03:16Pyl Trans#81-81
81 $850.00 MCRCLERK - MCR-City Clerk
MCR#: 401428
1 ITEM(S): TOTAL: $850!00
Check (305345) PAID $850.00
Have a nice day
'.Miscellaneous Cash Receipt k`�i , ' - � ,127121:111'.. - .
.CITY OF MIAMI BEACH
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