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VIRGINIA CONFLICT OF INTEREST AND ETHICS ADVISORY COUNCIL

Lobbyist Registration Form (Rev. 10/2016)

There is a $100 fee required for registration (local government employees are exempted from this fee). This form must be submitted electronically on the Council's website at ethics.dls.virginia.gov.

PART I: PRINCIPAL INFORMATION

Please provide the name of the Principal for which you intend to lobby

• 1.NAME OF PRINCIPAL:Sentara Healthcare
  
• Permanent Business Address:6015 Poplar Hall Drive Suite 300 Norfolk, VA 23502
• Business Telephone:757-455-7000




Please provide the type of business the Principal is engaged in

• 2.Type of Business:Integrated health care systems
  
  

  Please provide the name of the individual authorizing your employment as a lobbyist. The lobbyist filing this registration MAY NOT be the same as the Principal Officer.

• 3.NAME OF PRINCIPAL OFFICER:Anna Healy James


• Permanent Business Address:6015 Poplar Hall Drive Norfolk, VA 23502


• Business Telephone:804-901-3154


• E-Mail Address:ahjames@sentara.com




Please provide the name of the individual who will retain ALL records, on behalf of the Principal, with respect to your lobbying activities for their organization, if different from the Principal Officer.

• 4.NAME:Anna Healy James


• Permanent Business Address:6015 Poplar Hall Drive Norfolk, VA 23502


• Business Telephone:804-901-3154


• E-Mail Address:ahjames@sentara.com
  

PART II: LOBBYIST INFORMATION

Please provide the name of the Lobbyist registering to represent the Principal listed in Part I, item 1

1. 1.NAME OF LOBBYIST:Andrew Stephenson


2. Permanent Business Address:6015 Poplar Hall Drive Suite 101 Norfolk, VA 23502


3. Business Telephone:757-455-7117


4. E-Mail Address:apstephe@sentara.com




Please provide the name of the individual who will retain ALL records, on behalf of the Lobbyist, with respect to your lobbying activities for the Principal identified in Part I, item 1, if different from the Lobbyist listed in Part II, item 1

5. 2.NAME:Andrew Stephenson


6. Permanent Business Address:6015 Poplar Hall Drive Suite 101 Norfolk, VA 23502


7. Business Telephone:757-455-7117


8. E-Mail Address:apstephe@sentara.com

Identify the subject matter (with as much specificity as possible) for which you expect to lobby

1. 3.SUBJECT MATTER:All matters pertaining to Sentara Healthcare and its subsidiaries



Describe your relationship with the Principal listed in Part I, item 1 (check only one):

2. 4.As a lobbyist, you are:


3. Employed (on the payroll of the principal)
4. Retained (compensated but not on the payroll of the principal)
5. Not Compensated (not compensated but expenses may be reimbursed)



If you are employed by the Principal provide your job title

6. 5.JOB TITLE:Senior Community and Government Advocate

I, the undersigned lobbyist, do state that the information furnished on this registration statement and on any and all accompanying statements attached thereto, is to the best of my knowledge and belief, complete and accurate.

Date: 5/1/2020 11:43:43 AM       Lobbyist Signature: Andrew Stephenson (Electronically Signed:5/1/2020 11:43:43 AM )

Note: Pursuant to § 2.2-423, a principal may elect to waive the principal signature requirement on disclosure filings by submitting a signature waiver form to the Virginia Conflict of Interest and Ethics Advisory Council after this registration form has been approved.