Margaret Nee - Baptist Health South Florida, Inc. • 7o9 AA fon
RECEIVED
, •
MI A' :1 BEACH Office of the City Clerk
1700 Convention'Center Drive NOV 1 9 2019
Miami Beach,FL 33139
3Q5673.7.411 CITY OF MIAMI BEACH
LOBBYIST REGISTRATION FORM OFFICE OF THE CITY CLERK
Lobbyist means all persons employed or retainad,whether paid or not by a principal who seeks to encourage the passage defeat or
modification of any ordinance, reSelutien, action or decision of any commissioner, any action,dedision, recommendation of the City
Manager or any City board`or cernmittee',or any aCtion,decision or recommendation of any City personnel during the time period of the
entire decision making 'process on such ectien, decision or recommendation that foreseeably 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 in lobbying
activities.The term"Lobbyists'has specific exclusions. Please refer to City Code Chapter 2 Article VII, Division 3,entitled"Lobbyists,"
for additional information.
Instructions: 'Please complete all sections of this form and submit the completed form with the applicable fee,to the Office of the City
Clerk: If you need more space to complete an answer, use a separate sheet(s)of paper: If you have nothing to'report in a particular
section, you must write "none" or "nla" in that section. Any change'to any information originally filed, or any additional City
Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amendment to the registration form,.
The lobbyist has a continuing duty to supply information and amend the forms filed throughout the petiod that the lobbying ocCurs.
Separate registration forma Shall,be required for each principal rePresented on each specific issues
I. LOBBYIST INFORMATION:
Nee Margaret , Jean
NAME OF LOBBYIST - (Last) (First) (Middle Name)
Baptist.Health South Florida Inc., 8500 SW 117 Ave,Suite 101 Miami FL 33.183
LOBBYIST BUSINESS NAME AND ADDRESS :(Number and Street) (City) ' ,(State) (Zip Code)
786-594-6603 305-301-2702, :matgaretNegi.)aptiethealth.net
LOBBYISTBUSINESS TELEpHONE NUMBER "CELLULAR TELEPHONE NUMBER EMAIL ADDRESS'
II. PRINCIPAL INFORMATION:
Baptist Health South Florida Inc.- Ur.
NAMEOF PRINCIPAL (Last) • (First) Alliddle,Narne)
Baptist Health South FlOrida;Inc.. ,6855 Red Road COral,cables .FL 33143
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) • (State) gip Code)
Briankabaptisthealth net
786A62-7401 •
PRINCIPAL Etypiris TELEPHONE NUMBER CELLULAR TELEPHONE NyMI3ER EMAIL ADDRESS
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided
pursuant to City'COOP Section 2,482(0);
. .
• NAME OF cHIErOFFIcER,PARTNER,OR BENEFICIARY(If none,write NIA):._Brian E Keeley
• NAME OF ALL PERSONS,HOLDING,DIRECTLY OR INDIRECTLY,A 56/0.01i MORE OWNERSHIP INTEREST IN SUCH
CORPORATION,PARTNERSIlifi Olt TRUST(if none,mite N/A): .N/A
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astp•
III. ISSUE TO BE LOBBIED:
Describe with as much detail as is practical, including but not limited to a specific description where
applicable of a pending request for proposal, invitation to bid, or public hearing number.
Baptist Health Wellness and Medical Complex, located at 709 Alton Road, Miami Beach, FL
IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4), list the City Commissioner or City personnel sought to be
lobbied, and whether the lobbyist has entered into any contractual relationship (paid or unpaid) with
said City Commissioner or City personnel from 12 months preceding such commencement of service
with the City to the present date,stating the general nature of the subject contractual relationship.
Full Name of Individual and Contractual Relationship(If yes,explain) YES NO
Title of Person to be Lobbied
Mayor Dan Gelber x •
City Commissioners x
Planning Board members x
Planning &Zoning city staff members 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.
List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an
appearance of impropriety(if none,write N/A):
N/A
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION— Be Specific. (Note that a
contingency fee is prohibited pursuant to City Code Sec. 2-485.3):
$0
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The following six(6)questionsMUST be answered:
1) Pursuant to City Code Section 2-488,entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues":
_Yes X,No: Are vou lobbvinq on a present or pending bid for good s,equipment or services,or on a present or
pending award for goods.equipment or service?.
2) Pursuant to City Code Section 2-490,entitled"Prohibited Campaign Contributions By Lobbyists On Real;Estate Development
Issues":
_Yes X.No: Are vou 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 City Code Section 2-482(h), any person (except those exempt from the definition of"lobbyist' as set forth:in
Section 2-481)who only appears as a representative of a not for-profit corporation or entity'without.special compensation or
reimbursement for the appearance,whether director indirect to express support of or opposition to any item,shall register with
the city clerk as required by this section,but shall not be required to pay any registration fees.
)(Yes No: Are vou representing a not-for-profit corporation orentity without special compensation or
reimbursement?
4) Pursuant to City Code Section 2-481, the term "lobbyist" specifically excludes the following persons: Expert witnesses who
provide only scientific,technical or other specialized information.of testimony in public meetings;any person who only appears
as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether direct,
indirect orcontingent,to express support of or opposition to any item;and any,person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or
reimbursement for the appearance.,
_Yes XNo: Are .vou providing only scientific, technical or other :specialized information; appearing as a
representative of a neighborhood association without special compensation or reimbursement or
representing a not-for-profit based 'organization for the 'purpose of requesting a grant without
special compensation'or;reimbursement?'
5) Pursuant to City_Code'Section 2-491(1), no campaign consultant shall lobby the City Commission for a period of 12 months
following the swearing in of any.elected official(s)for whom the:campaign.consultant provided campaign:consulting services
within the past election cycle.See Section 2-491 for more information.
_Yes xNo Have you provided campaign consulting services to an'incumbent member of the City Commission
within the past election cycle?if yes,please list the incumbent member(s)of the City Commission:
—Yes No: if ve has it been less than 1, months since he elected afficial(s whom ou •r'vided cam a al.
co sultings aerviees was sworn fm . - -
6) Pursuant to City Code Section 2-482(a)(4)a.,a lobbyist who has within the past election cycle provided campaign consulting
Services to an incumbent member of the:City Commission`.(which lobbying activity is'mit otherwise prohibited by Code section
'2-491) shall, disclose such particular service on his/her lobbyist registration form and.shall orally disclose such.particular
service before lobbying the City Commission at a public meeting.
_Yes iNo: Have vou provided'campaign consulting services to an incumbent member of the City Commission
within the past election circle?If yes,please list the incumbent member(s)of the City Commission:
_Yes_No .:f vas,we > au .r i e. or did you receive economic coni sid ration i e change for mai
s icing se ices :.,
TO BE COMPLETED BY CITY CLERK'S STAFF:'ONLLYY°_
Annual•Registratlon;fee [. ]Yes[ No Amount Paid$ _MCR.# i' T Date Paid
Lobbyist Registration Form received and verifiediby �
. "�� =<� -' fir '
F\GLF.R\$t�I:L\aiORMS\LDDBVEST,{FarRN4S\Labbyist,Registratron Form Revised 01-01-18 RSG doc Revised Ot/01/20]8,
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, .
VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNED STATEMENT' UNDER OATH, LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATION
RECEIVED. FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAGED TO' LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMpENSATION DURING THE REPQ,1RTING PERIOD'
• • AI ' ' : - ' 6 t
Signature of Lobbyist. , - a e 11/15/19
I do solemnly swear or affirm that all.Of th foregoing facts, Statements, and disclosures in this form are true and correct,
and that I have read or am familiar with t e provisions a 4airied 'ri Chapter 2, Art VII, Division 3, entitled "Lobbyists" of
the Miami Beach City Coder9 ,II reporting requirements.
Signature of Lobbyist . AI. _ It : 4 -: -- Date 11/15/19
fLiTiri.
Signature of Principal: i rri _ _IAA/' Date 11/icW19
1 v -
IP
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of Florida State of Florida
. .
County of Miami-Dade County of Miami-Dade
Sworn teaor affirmed)and subscribed before Me Sworn,to.(or affirnied)and subscribed before me
thie /sr day of'November ,2019,by thiS[ day of November ,2019, by
_.
Margaret Née P Vtito– VeA Zir
NAME OF LOBBYIST NAME OF PRINCIPAL
Produced ID'. , Prodtited ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
4ersonally Known X PersOnally Known
—
Sign.-–r= :"17. ---=7O'_ , Signature of Il otary Pub!'
gpla 4, Notary Public State of Flonaa
Nuncy9rtege
, •4 r. . q iul Co is,, e t i
Na - oNisfrary -ITP*11,14(litbd or Ste 4:ed Name of Notary iigo: nn id cif§%mei
dt o ary u lc o Ronda
' f Ittf ; Maryann Patricia Zaldivar
My Commission GG 182171
(NOTARY SEAL) (NOTARY 8 EA Ili) 44 0,t,:cp Expires 04/15/2022
1 The term 'lobbyist'specifically excludes the following persons:
Expert witnesses who provide only scientific technical Or other specialized information or testimony in public meetings any person,who
only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether
direct,.indirect or contingent to express support of or opposition to any Ref*and any person-Who only appears as a representative of
not-for-profit community based organization for the,purpose of requesting a grant without special compensation or reimbursement for
the appearanoe.
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MIAMI BEACH
Mianii Beach,Florida 33139,miwaniamibeachfl.gav
Office-of the City Clerk
Rafael E Oranadci;City Clerk CityClerlArpiainibeachfl.gov
Tel:305.673.7411,Fax:305.673.7254
NAME OF LOBBYIST: Margaret Nee
1) LOBBYIST FEE'EXPENDITURE AND COMPENSATION STATEMENT
Pursuant to City Code Section 2-485(d), the City Clerk shall notify any lobbyist (or
principal)who fails to file timely a Lobbyist Fee Expenditure and Compensation Statement
(Statement), In addition to any other penalties that may be imposed as provided in
Section 2-485.1, a fine of $50.00 a day shall be assessed for Statements 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 Miami-Dade County Commission on Ethics and Public Trust.
I hereby acknowledge that on February 28 of each year; I shall submit.to the city Clerk a
signed Statement under oath listing all lobbyist expenditures, as Well as compensation
received, for the preceding calendar year with regard to the specific issue on which I have
been engaged ttft lObby:
2) LOBBYIST WITHDRAWAL
Once an issue I have registered tO lobby has concluded or I am no longer lobbying on
that issue, I shall immediately file a Notice of Withdrawal with the Office of the City Clerk..
3) ANNUAL LOBBYIST REGISTRATION FEE
I understand annual registration of all lobbyists shall be required for each 12-month period
Commencing :October 1 of each year, and the fee for such annual registration shall be
$500:00 pursuant:to Sec ' ,482 of the Miami Peaoh City Code,
.
- ' 11/15/19
Signature of 1.-01:10Y.J Date
FACLERLSALMFORMS1140138YIST FORMS1LobbylaReglstmliop Form FtevlsOcl 01-01-18 REG.doc
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