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11 Date Submitted: 2/18/2015 3:19:52 PM As a general matter, applications for all positions within state Government are public records, which may be viewed by anyone upon request. However, there are some exemptions from the public records law for identifying information relating to past and present law enforcement officers and their families, victims of certain crimes, etc. If you believe an exemption from the public records law applies to portions of your application, please check this box. Contact 1- General Title Dr. First Name Michael Middle/Maiden Roger Last Name Busatto Address Cell Phone Race Caucasian Gender Male Fax Disability Addresses Speficy the preferred mailing address: Business 2- Residence Address Line SW 21 St Address Line 2 City Miami State Florida County Miami-Dade Zip / Postal Code Phone Number 3- Business Address Line SW 160 Ave 3rd Floor Address Line 2 City Miramar State Florida Zip / Postal Code Phone Number Other Residences 4-A. List all your places of residence for the last ten (10) years. Address City & State Start Date End Date 7/28/2015 3:12:06 PM 1 of 6

12 Date Submitted: 2/18/2015 3:19:52 PM 4-B. List all your former and current residences outside of Florida that you have maintained at any time during adulthood. Address City & State Start Date End Date Personal Information 5- Date of Birth 01/05/1957 Place of Birth Toronto, Canada 6- Driver License # B Issuing State Florida 7- Social Security # s (5)(a), F.S. 8- Have you ever used or been known by any other legal name? 9- A. Are you a United States citizen? Yes B. If you are a naturalized citizen, date of naturalization 8/2/ Since what year have you been a continuous resident of Florida? Vote Are you a registered Florida voter? Yes County of registration Miami-Dade Current Party Affiliation Republican Education 12-A. High School Miami Central High School Year Graduated 1975 B. List all postsecondary educational institutions attended Name & Location Start Date End Date Certificates / Degrees Received University of Miami BS Biology University of Florida BS Pharmacy va Southeastern University Pharm.D. Employment 13- Are you or have you ever been a member of the armed forces of the United States? A. Date of Service B. Branch or component 7/28/2015 3:12:06 PM 2 of 6

13 Date Submitted: 2/18/2015 3:19:52 PM C. Date & Type of Discharge 14- Concerning your current employer and for all of your employment during the last ten years, list your employer s name, business address, type of business, occupation or job title, and period(s) of employment. Employer's Name & Address Type of Business Occupation / Job Title Humana 3401 SW 160 Ave Miramar Florida Managed care Clinical Pharmacist Pharmacy manager Start Date End Date YTD 15- Have you ever been employed by any state, district, or local governmental agency in Florida? Position Employing Agency Start Date End Date Appointments 16- A. State your experiences and interests or elements of your personal history that qualify you for this appointment B. Have you received any degree(s), professional certification(s), or designations(s) related to the subject matter of this appointment? Extensive experience in the managed care setting and formulary management. C. Have you received any awards or recognitions relating to the subject matter of this appointment? D. Identify all association memberships and association offices held by you that relate to this appointment Academy of Managed Care Pharmacy 17- Do you currently hold an office or position (appointive, civil service, or other) with the federal or any foreign government? 18- Have you previously been appointed to any office that required confirmation by the Florida Senate? Title of Office Term of Appointment Confirmation Result 19- A. Have you ever been elected or appointed to any public office in this state? 7/28/2015 3:12:06 PM 3 of 6

14 Date Submitted: 2/18/2015 3:19:52 PM Office Title Date of Election or Appointment Term of Office Level of Government (city, county, district, state, federal) B. If your service was on an appointed board(s), committee(s), or council(s) 1- How frequently were meetings scheduled 2- If you missed any of the regularly scheduled meetings, state the number of meetings you attended, the number you missed, and the reasons(s) for your absence(s) Meetings Attended Meetings Missed Reason for Absence Violation 20- Have you ever been arrested, charged, or indicted for violation of any federal, state, county, or municipal law, regulation, or ordinance? (Exclude traffic violations for which a fine or civil penalty of $150 or less was paid.) Date Place Nature Disposition 21- Has probable cause ever been found that you were in violation of the Code of Ethics for Public Officers and Employees, Part III, Chapter 112, F.S.? Date Nature of Violation Disposition 22- Have you ever been suspended from any office by the Governor of the State of Florida? Title of Office Reason of Suspension Date of Suspension Result Please Select 23- Have you ever been refused a fidelity, surety, performance, or other bond? Certifications 24- Have you held or do you hold an occupational or professional license or certificate in the State of Florida? Yes Error: Subreport could not be shown. 25- Have you ever been a registered lobbyist or have you lobbied at any level of government at any time during the past five (5) years? A. Did you receive any compensation other than reimbursement for expenses? B. Name of agency or entity you lobbied and the principal(s) you represented 7/28/2015 3:12:06 PM 4 of 6

15 Date Submitted: 2/18/2015 3:19:52 PM Agency Lobbies Principal Represented Disclosures 26- If required by law or administrative rule, will you file financial disclosure statements? Yes 27- A. Have you, or businesses of which you have been an owner, officer, or employee, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Yes Name of Business Your Relationship to Business Business Relationship to Agency Humana Inc Employee Humana has contracts with the Agency for Health Care Administration. B. Have members of your immediate family (spouse, child, parents(s), siblings(s)), or businesses of which members of your immediate family have been owners, officers, or employees, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Yes Name of Business References & Affiliations Family Member's Relationship to You Family Member's Relationship to Business Business Relationship to Agency Mercy Hospital Spouse Employee Mercy Hospital treats Humana Family Medicaid patients. 28- List three persons who have known you well within the past five (5) years. Include a current, complete address and telephone number. Exclude your relatives and members of the Florida Senate. Name Mailing Address Zip Code Phone Number Dr. Jill Sumfest 3501 SW 160 Ave 4th Floor Miramar, Fl Alaina Gibson Pharm.D Boy Scout Blvd Suite 1000 Tampa, Fl Dr. Hector Fernandez 7150 W 20 Ave Suite 202 Hialeah, Fl Name any business, professional, occupational, civic, or fraternal organizations(s) of which you are now a member, or of which you have been a member during the past five (5) years, the organization address(es), and date(s) of your membership(s) Name Mailing Address Office(s) Held & Term Date of Membership Academy of Managed Care Pharmacy 100 rth Pitt Street Suite 400 Alexandria, Va ne #Error 30- Do you know of any reason why you will not be able to attend fully to the duties of the office or position to which you have been or will be appointed? 7/28/2015 3:12:06 PM 5 of 6

16 Date Submitted: 2/18/2015 3:19:52 PM 31- Are you now, or in the past three years have you been, a member of any club or organization that, to your knowledge, in practice or policy, restricts membership or restricted membership during the time that you belonged on the basis of race, religion, national origin, or gender? If so, detail the name and nature of the club(s) or organization(s), relevant policies and practices, and state whether you intend to continue as a member if you appointed by the Governor? Boards of Interest Functional Category Medical & Health Medical & Health Medical & Health Medical & Health Medical & Health Board Name Seat Seat Qualification Reappointment Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee 1 Governor appoints 5 pharmacists who are licensed under Chapter Governor appoints 5 pharmacists who are licensed under Chapter Governor appoints 5 pharmacists who are licensed under Chapter Governor appoints 5 pharmacists who are licensed under Chapter Governor appoints 5 pharmacists who are licensed under Chapter /28/2015 3:12:06 PM 6 of 6

17 Date Submitted: 1/29/2015 6:03:24 PM As a general matter, applications for all positions within state Government are public records, which may be viewed by anyone upon request. However, there are some exemptions from the public records law for identifying information relating to past and present law enforcement officers and their families, victims of certain crimes, etc. If you believe an exemption from the public records law applies to portions of your application, please check this box. Contact 1- General Title Ms. First Name Eunice Middle/Maiden Nuekie Last Name Cofie Address Cell Phone Race African-American Gender Female Fax Disability Addresses Speficy the preferred mailing address: Business 2- Residence Address Line Conservancy Drive East Address Line 2 City Tallahassee State Florida County Leon Zip / Postal Code Phone Number 3- Business Address Line 1 P.O. Box 7018 Address Line 2 City Tallahassee State Florida Zip / Postal Code Other Residences Phone Number 4-A. List all your places of residence for the last ten (10) years. Address City & State Start Date End Date 7/28/2015 3:54:02 PM 1 of 6

18 Date Submitted: 1/29/2015 6:03:24 PM 4-B. List all your former and current residences outside of Florida that you have maintained at any time during adulthood. Address City & State Start Date End Date Personal Information 5- Date of Birth 07/28/1980 Place of Birth Lexington, KY 6- Driver License # C Issuing State Florida 7- Social Security # s (5)(a), F.S. 8- Have you ever used or been known by any other legal name? 9- A. Are you a United States citizen? Yes B. If you are a naturalized citizen, date of naturalization 10- Since what year have you been a continuous resident of Florida? Vote Are you a registered Florida voter? Yes County of registration Leon Current Party Affiliation Party Affiliation Education 12-A. High School Leon High School Year Graduated 1998 B. List all postsecondary educational institutions attended Name & Location Start Date End Date Certificates / Degrees Received Florida Agricultural and Mechanical University, Tallahassee, FL University of South Florida, Tampa, FL Harvard Kennedy School of Government Executive Education Program, Boston, MA Employment 13- Are you or have you ever been a member of the armed forces of the United States? A. Date of Service 8/ /2004 B.S. in Chemistry 8/ /2010 ne 4/2013 4/2013 Global Leadership and Public Policy for the 21st Century Certificate 7/28/2015 3:54:02 PM 2 of 6

19 Date Submitted: 1/29/2015 6:03:24 PM C. Date & Type of Discharge B. Branch or component 14- Concerning your current employer and for all of your employment during the last ten years, list your employer s name, business address, type of business, occupation or job title, and period(s) of employment. Employer's Name & Address Type of Business Occupation / Job Title Nuekie, Inc., 3000 Commonwealth Blvd., Tallahassee, FL Institute for African American Health, Tallahassee, FL Health and Beauty products Start Date End Date President 11/2003 Current n Profit Assistant Coordinator 11/ / Have you ever been employed by any state, district, or local governmental agency in Florida? Yes Position Employing Agency Start Date End Date Program Assistant Florida State University 12/2010 8/2013 Program Assistant Florida Agricultural and Mechanical University 01/ /2005 Appointments 16- A. State your experiences and interests or elements of your personal history that qualify you for this appointment I have trained cosmetologists and estheticians at national conferences on the topic of skin health conditions in people of color. So, I have experience in developing curriculum. I also am the founder of an innovative health and beauty product company for people of color called Nuekie. I am an expert in cosmetic science and I have conducted research, written articles, and spoken on the topic to professional organizations and academic institutions. C. Have you received any awards or recognitions relating to the subject matter of this appointment? Yes B. Have you received any degree(s), professional certification(s), or designations(s) related to the subject matter of this appointment? Yes I have a B.S. degree in Chemistry/Molecular Biology. I have completed two entrepreneurship programs and obtained a certificate from Harvard Kennedy School of Government in Global Leadership. D. Identify all association memberships and association offices held by you that relate to this appointment Society of Cosmetic Chemists Cosmetic Executive Women Skin of Color Society 7/28/2015 3:54:02 PM 3 of 6

20 Date Submitted: 1/29/2015 6:03:24 PM 17- Do you currently hold an office or position (appointive, civil service, or other) with the federal or any foreign government? 18- Have you previously been appointed to any office that required confirmation by the Florida Senate? Title of Office Term of Appointment Confirmation Result 19- A. Have you ever been elected or appointed to any public office in this state? Office Title Date of Election or Appointment Term of Office Level of Government (city, county, district, state, federal) B. If your service was on an appointed board(s), committee(s), or council(s) 1- How frequently were meetings scheduled 2- If you missed any of the regularly scheduled meetings, state the number of meetings you attended, the number you missed, and the reasons(s) for your absence(s) Meetings Attended Meetings Missed Reason for Absence Violation 20- Have you ever been arrested, charged, or indicted for violation of any federal, state, county, or municipal law, regulation, or ordinance? (Exclude traffic violations for which a fine or civil penalty of $150 or less was paid.) Date Place Nature Disposition 21- Has probable cause ever been found that you were in violation of the Code of Ethics for Public Officers and Employees, Part III, Chapter 112, F.S.? Date Nature of Violation Disposition 22- Have you ever been suspended from any office by the Governor of the State of Florida? Title of Office Reason of Suspension Date of Suspension Result Please Select 23- Have you ever been refused a fidelity, surety, performance, or other bond? 7/28/2015 3:54:02 PM 4 of 6

21 Date Submitted: 1/29/2015 6:03:24 PM Certifications 24- Have you held or do you hold an occupational or professional license or certificate in the State of Florida? Error: Subreport could not be shown. 25- Have you ever been a registered lobbyist or have you lobbied at any level of government at any time during the past five (5) years? A. Did you receive any compensation other than reimbursement for expenses? B. Name of agency or entity you lobbied and the principal(s) you represented Agency Lobbies Principal Represented Disclosures 26- If required by law or administrative rule, will you file financial disclosure statements? Yes 27- A. Have you, or businesses of which you have been an owner, officer, or employee, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Yes Name of Business Your Relationship to Business Business Relationship to Agency Nuekie, Inc. President Florida Department of Health B. Have members of your immediate family (spouse, child, parents(s), siblings(s)), or businesses of which members of your immediate family have been owners, officers, or employees, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Family Member's Relationship to You Family Member's Relationship to Business Business Relationship to Agency References & Affiliations 28- List three persons who have known you well within the past five (5) years. Include a current, complete address and telephone number. Exclude your relatives and members of the Florida Senate. Name Mailing Address Zip Code Phone Number Dr. Paa Kofi Obeng 800 Benevita Place, Apt. 402, Hampton, VA Dr. Alisha Jones 3400 S. Sara Rd., Apt. 1106, Bloomington, IN Dr. Candrice Heath 10 Amsterdam Ave., Apt. 906, New York, New York /28/2015 3:54:02 PM 5 of 6

22 29- Name any business, professional, occupational, civic, or fraternal organizations(s) of which you are now a member, or of which you have been a member during the past five (5) years, the organization address(es), and date(s) of your membership(s) Name Mailing Address Office(s) Held & Term Date of Membership Society of Cosmetic Chemists Skin of Color Society Cosmetic Executive Women 120 Wall Street, Suite 2400, NY, NY West State Street, Geneva, Illnois Madison Avenue, 19th Floor, NY, NY GOVERNOR'S OFFICE Date Submitted: 1/29/2015 6:03:24 PM ne 12/31/2013 ne 02/28/2014 ne 12/31/ Do you know of any reason why you will not be able to attend fully to the duties of the office or position to which you have been or will be appointed? 31- Are you now, or in the past three years have you been, a member of any club or organization that, to your knowledge, in practice or policy, restricts membership or restricted membership during the time that you belonged on the basis of race, religion, national origin, or gender? If so, detail the name and nature of the club(s) or organization(s), relevant policies and practices, and state whether you intend to continue as a member if you appointed by the Governor? Boards of Interest Functional Category Board Name Seat Seat Qualification Reappointment DBPR Board of Cosmetology 6 Lay Members Medical & Health Medicaid Pharmaceutical and Therapeutics Committee 11 Governor appoints 1 member who is a consumer representative. 7/28/2015 3:54:02 PM 6 of 6

23 Date Submitted: 4/8/2015 9:57:12 AM As a general matter, applications for all positions within state Government are public records, which may be viewed by anyone upon request. However, there are some exemptions from the public records law for identifying information relating to past and present law enforcement officers and their families, victims of certain crimes, etc. If you believe an exemption from the public records law applies to portions of your application, please check this box. Yes Contact 1- General Title Dr. First Name Erin Middle/Maiden Chistine Last Name Duffy Address Cell Phone s (4)(d), F.S. Race Caucasian Gender Female Fax Disability Addresses Speficy the preferred mailing address: Residential 2- Residence Address Line 1 s (4)(d), F.S. Address Line 2 City s (4)(d), F.S. State s (4)(d), F County s (4)(d), F.S Zip / Postal Code s (4)(d) Phone Number s (4)(d), F.S. 3- Business Address Line George Rd Address Line 2 City Tampa State Florida Zip / Postal Code Phone Number Other Residences 4-A. List all your places of residence for the last ten (10) years. 7/28/2015 3:18:08 PM 1 of 6

24 Date Submitted: 4/8/2015 9:57:12 AM Address City & State Start Date End Date s (4)(d), F.S. s (4)(d), F.S. 09/01/1997 Present 4-B. List all your former and current residences outside of Florida that you have maintained at any time during adulthood. Address City & State Start Date End Date Personal Information 5- Date of Birth s (4)(d), F.S. Place of Birth Bethpage, NY 6- Driver License # D Issuing State Florida 7- Social Security # s (5)(a), F.S. 8- Have you ever used or been known by any other legal name? 9- A. Are you a United States citizen? Yes B. If you are a naturalized citizen, date of naturalization 10- Since what year have you been a continuous resident of Florida? Vote Are you a registered Florida voter? Yes County of registration Pinellas Current Party Affiliation Party Affiliation Education 12-A. High School Palm Harbor University High School B. List all postsecondary educational institutions attended Year Graduated 2002 Name & Location Start Date End Date Certificates / Degrees Received Saint Petersburg College 01/01/ /01/2005 Associates of Arts University of South Florida 01/01/ /01/2007 Bachelor of Science Touro College of Pharmacy 09/01/ /01/2012 Doctorate of Pharmacy Employment 13- Are you or have you ever been a member of the armed forces of the United States? 7/28/2015 3:18:08 PM 2 of 6

25 A. Date of Service B. Branch or component C. Date & Type of Discharge 14- Concerning your current employer and for all of your employment during the last ten years, list your employer s name, business address, type of business, occupation or job title, and period(s) of employment. Employer's Name & Address Type of Business Occupation / Job Title WellCare Health Plans 4110 Geroge Rd Tampa, FL Walgreens Pharmacy 353 West 57th St New York, New York Walgreens Pharmacy rd Avenue New York, NY WellCare Health Plans 8725 Henderson Rd Tampa, FL Walgreens Pharmacy 1701 McMullen Booth Rd Clearwater, FL GOVERNOR'S OFFICE Managed Care Manager of Pharmacy Operations Start Date End Date 01/06/201 4 Retail Pharmacy Floater Pharmacist 07/01/201 2 Retail Pharmacy Pharmacy Intern 10/01/201 0 Managed Care Retail Pharmacy Date Submitted: 4/8/2015 9:57:12 AM Certified Pharmacy Technician Certified Pharmacy Technician 06/01/ /30/200 3 Present 01/06/ /01/ /01/ /01/ Have you ever been employed by any state, district, or local governmental agency in Florida? Position Employing Agency Start Date End Date Appointments 16- A. State your experiences and interests or elements of your personal history that qualify you for this appointment B. Have you received any degree(s), professional certification(s), or designations(s) related to the subject matter of this appointment? I have almost three years of experience in the managed care field where I can see the direct effects of a formulary and have also worked with the formulary team within my company in helping to decide when to add or remove an item from the formulary. C. Have you received any awards or recognitions relating to the subject matter of this appointment? D. Identify all association memberships and association offices held by you that relate to this appointment ne 7/28/2015 3:18:08 PM 3 of 6

26 Date Submitted: 4/8/2015 9:57:12 AM 17- Do you currently hold an office or position (appointive, civil service, or other) with the federal or any foreign government? 18- Have you previously been appointed to any office that required confirmation by the Florida Senate? Title of Office Term of Appointment Confirmation Result 19- A. Have you ever been elected or appointed to any public office in this state? Office Title Date of Election or Appointment Term of Office Level of Government (city, county, district, state, federal) B. If your service was on an appointed board(s), committee(s), or council(s) 1- How frequently were meetings scheduled 2- If you missed any of the regularly scheduled meetings, state the number of meetings you attended, the number you missed, and the reasons(s) for your absence(s) Meetings Attended Meetings Missed Reason for Absence Violation 20- Have you ever been arrested, charged, or indicted for violation of any federal, state, county, or municipal law, regulation, or ordinance? (Exclude traffic violations for which a fine or civil penalty of $150 or less was paid.) Date Place Nature Disposition 21- Has probable cause ever been found that you were in violation of the Code of Ethics for Public Officers and Employees, Part III, Chapter 112, F.S.? Date Nature of Violation Disposition 22- Have you ever been suspended from any office by the Governor of the State of Florida? Title of Office Reason of Suspension Date of Suspension Result Please Select 23- Have you ever been refused a fidelity, surety, performance, or other bond? 7/28/2015 3:18:08 PM 4 of 6

27 Date Submitted: 4/8/2015 9:57:12 AM Certifications 24- Have you held or do you hold an occupational or professional license or certificate in the State of Florida? Yes Error: Subreport could not be shown. 25- Have you ever been a registered lobbyist or have you lobbied at any level of government at any time during the past five (5) years? A. Did you receive any compensation other than reimbursement for expenses? B. Name of agency or entity you lobbied and the principal(s) you represented Agency Lobbies Principal Represented Disclosures 26- If required by law or administrative rule, will you file financial disclosure statements? 27- A. Have you, or businesses of which you have been an owner, officer, or employee, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Your Relationship to Business Business Relationship to Agency B. Have members of your immediate family (spouse, child, parents(s), siblings(s)), or businesses of which members of your immediate family have been owners, officers, or employees, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Family Member's Relationship to You Family Member's Relationship to Business Business Relationship to Agency References & Affiliations 28- List three persons who have known you well within the past five (5) years. Include a current, complete address and telephone number. Exclude your relatives and members of the Florida Senate. Name Mailing Address Zip Code Phone Number Philip Stalas 4110 George Rd Suite 300 Tampa, FL Ryan Nimtz 1124 Moody Ave Tampa, FL Elizabeth Dawson 301 east 75th st Apt 2G Name any business, professional, occupational, civic, or fraternal organizations(s) of which you are now a member, or of which you have been a member during the past five (5) years, the organization address(es), and date(s) of your membership(s) 7/28/2015 3:18:08 PM 5 of 6

28 Name Mailing Address Office(s) Held & Term Date of Membership National association of specialty Pharmacy 1765 Duke St, Alexandira, VA GOVERNOR'S OFFICE Date Submitted: 4/8/2015 9:57:12 AM Member #Error 30- Do you know of any reason why you will not be able to attend fully to the duties of the office or position to which you have been or will be appointed? 31- Are you now, or in the past three years have you been, a member of any club or organization that, to your knowledge, in practice or policy, restricts membership or restricted membership during the time that you belonged on the basis of race, religion, national origin, or gender? If so, detail the name and nature of the club(s) or organization(s), relevant policies and practices, and state whether you intend to continue as a member if you appointed by the Governor? Boards of Interest Functional Category Medical & Health Medical & Health Medical & Health Medical & Health Medical & Health Board Name Seat Seat Qualification Reappointment Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee 1 Governor appoints 5 pharmacists who are licensed under Chapter Governor appoints 5 pharmacists who are licensed under Chapter Governor appoints 5 pharmacists who are licensed under Chapter Governor appoints 5 pharmacists who are licensed under Chapter Governor appoints 5 pharmacists who are licensed under Chapter /28/2015 3:18:08 PM 6 of 6

29 Date Submitted: 2/18/2015 9:30:17 AM As a general matter, applications for all positions within state Government are public records, which may be viewed by anyone upon request. However, there are some exemptions from the public records law for identifying information relating to past and present law enforcement officers and their families, victims of certain crimes, etc. If you believe an exemption from the public records law applies to portions of your application, please check this box. Yes Contact 1- General Title Dr. First Name Jodi Middle/Maiden Ellen Last Name Fredericks Address Cell Phone s (4)(d), F.S. Race Caucasian Gender Female Fax Disability Addresses Speficy the preferred mailing address: Residential 2- Residence Address Line 1 s (4)(d), F.S. Address Line 2 City s (4)(d State s (4)(d), F County s (4)(d), F.S. Zip / Postal Code s (4)(d) Phone Number s (4)(d), F.S. 3- Business Address Line Harrison Parkway Address Line 2 City Sunrise State Building H, Suite 200 Florida Zip / Postal Code Phone Number Other Residences 4-A. List all your places of residence for the last ten (10) years. 7/28/2015 3:10:35 PM 1 of 6

30 Date Submitted: 2/18/2015 9:30:17 AM Address City & State Start Date End Date s (4)(d), F.S. s (4)(d), F.S. s (4)(d), F.S. s (4)(d), F.S. March 2010 present Sept B. List all your former and current residences outside of Florida that you have maintained at any time during adulthood. Address City & State Start Date End Date Personal Information 5- Date of Birth s (4)(d), F.S. Place of Birth Falmouth, MA 6- Driver License # F Issuing State Florida 7- Social Security # s (5)(a), F.S. 8- Have you ever used or been known by any other legal name? Yes Jodi Ellen Beck (Maiden Name) 9- A. Are you a United States citizen? Yes B. If you are a naturalized citizen, date of naturalization 10- Since what year have you been a continuous resident of Florida? Vote Are you a registered Florida voter? Yes County of registration Broward Current Party Affiliation Republican Education 12-A. High School University School of va University B. List all postsecondary educational institutions attended Year Graduated 1992 Name & Location Start Date End Date Certificates / Degrees Received va Southeastern University College of Pharmacy, Fort Lauderdale, FL va Southeastern University Huizenga School of Business, Fort Lauderdale, FL Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA August 1995 May 1999 Doctor of Pharmacy Jan Oct Masters in Business Administration with a concentration in Health Services Administration July 1999 June 2000 Residency in AMbulatory Care Pharmacotherapy 7/28/2015 3:10:35 PM 2 of 6

31 Date Submitted: 2/18/2015 9:30:17 AM University of Florida, Gainesville, FL Aug.1992 May 1995 Associates of Arts Employment 13- Are you or have you ever been a member of the armed forces of the United States? A. Date of Service B. Branch or component C. Date & Type of Discharge 14- Concerning your current employer and for all of your employment during the last ten years, list your employer s name, business address, type of business, occupation or job title, and period(s) of employment. Employer's Name & Address Type of Business Occupation / Job Title South Florida Community Care Network, 1643 Harrison Parkway, Bldg. H, Suite 200, Sunrise, FL Memorial Healthcare System, 1131 N. 35 Ave, Hollywood, FL Memorial Healthcare System, 2900 Corporate Way, Suite C, Miramar, FL Provider Service Network Health Plan Healthcare System Healthcare System Director of Pharmacy Services Pharmacy Safety and Medication Officer Director of Pharmacy Contracting Start Date End Date July 2014 present Aug July 2014 Oct July Have you ever been employed by any state, district, or local governmental agency in Florida? Position Employing Agency Start Date End Date Appointments 16- A. State your experiences and interests or elements of your personal history that qualify you for this appointment I chaired Memorial Healthcare System's District Formulary Committee for eight years and was responsible for new drug requests, drug evaluation, automatic substitutions, and deletions and/or additions to the formulary. In addition, as Director of Pharmacy Contracting for Memorial Healthcare System, I analyzed contracts and drug pricing to present cost savings to the system and analyze safety, efficacy, rebates, cost savings/impact, etc. C. Have you received any awards or recognitions relating to the subject matter of this appointment? B. Have you received any degree(s), professional certification(s), or designations(s) related to the subject matter of this appointment? Yes Doctor of Pharmacy (Pharm.D.), Masters in Business Administration (MBA) with a concentration in Health Services Administration (HSA). D. Identify all association memberships and association offices held by you that relate to this appointment 7/28/2015 3:10:35 PM 3 of 6

32 Date Submitted: 2/18/2015 9:30:17 AM Academy of Managed Care Pharmacy (AMCP)- member 17- Do you currently hold an office or position (appointive, civil service, or other) with the federal or any foreign government? 18- Have you previously been appointed to any office that required confirmation by the Florida Senate? Title of Office Term of Appointment Confirmation Result 19- A. Have you ever been elected or appointed to any public office in this state? Office Title Date of Election or Appointment Term of Office Level of Government (city, county, district, state, federal) B. If your service was on an appointed board(s), committee(s), or council(s) 1- How frequently were meetings scheduled 2- If you missed any of the regularly scheduled meetings, state the number of meetings you attended, the number you missed, and the reasons(s) for your absence(s) Meetings Attended Meetings Missed Reason for Absence Violation 20- Have you ever been arrested, charged, or indicted for violation of any federal, state, county, or municipal law, regulation, or ordinance? (Exclude traffic violations for which a fine or civil penalty of $150 or less was paid.) Date Place Nature Disposition 21- Has probable cause ever been found that you were in violation of the Code of Ethics for Public Officers and Employees, Part III, Chapter 112, F.S.? Date Nature of Violation Disposition 22- Have you ever been suspended from any office by the Governor of the State of Florida? Title of Office Reason of Suspension Date of Suspension Result Please Select 23- Have you ever been refused a fidelity, surety, performance, or other bond? 7/28/2015 3:10:35 PM 4 of 6

33 Date Submitted: 2/18/2015 9:30:17 AM Certifications 24- Have you held or do you hold an occupational or professional license or certificate in the State of Florida? Yes Error: Subreport could not be shown. 25- Have you ever been a registered lobbyist or have you lobbied at any level of government at any time during the past five (5) years? A. Did you receive any compensation other than reimbursement for expenses? B. Name of agency or entity you lobbied and the principal(s) you represented Agency Lobbies Principal Represented Disclosures 26- If required by law or administrative rule, will you file financial disclosure statements? Yes 27- A. Have you, or businesses of which you have been an owner, officer, or employee, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Your Relationship to Business Business Relationship to Agency B. Have members of your immediate family (spouse, child, parents(s), siblings(s)), or businesses of which members of your immediate family have been owners, officers, or employees, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Family Member's Relationship to You Family Member's Relationship to Business Business Relationship to Agency References & Affiliations 28- List three persons who have known you well within the past five (5) years. Include a current, complete address and telephone number. Exclude your relatives and members of the Florida Senate. Name Mailing Address Zip Code Phone Number John Benz 1643 Harrison Parkway, Bldg H, Suite 200, Sunrise, FL Dr. Stanley Marks 1131 N. 35 Ave, 3rd Floor, Hollywood, FL /28/2015 3:10:35 PM 5 of 6

34 Date Submitted: 2/18/2015 9:30:17 AM Dr. Keith Fricker 2900 Corporate Way, Suite C, Miramar, FL Name any business, professional, occupational, civic, or fraternal organizations(s) of which you are now a member, or of which you have been a member during the past five (5) years, the organization address(es), and date(s) of your membership(s) Name Mailing Address Office(s) Held & Term Date of Membership Academy of Managed Care Pharmacy 100 rth Pitt Street, Suite 400, Alexandria, VA member 07/31/ Do you know of any reason why you will not be able to attend fully to the duties of the office or position to which you have been or will be appointed? 31- Are you now, or in the past three years have you been, a member of any club or organization that, to your knowledge, in practice or policy, restricts membership or restricted membership during the time that you belonged on the basis of race, religion, national origin, or gender? If so, detail the name and nature of the club(s) or organization(s), relevant policies and practices, and state whether you intend to continue as a member if you appointed by the Governor? Boards of Interest Functional Category Medical & Health Medical & Health Medical & Health Medical & Health Medical & Health Board Name Seat Seat Qualification Reappointment Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee 1 Governor appoints 5 pharmacists who are licensed under Chapter Governor appoints 5 pharmacists who are licensed under Chapter Governor appoints 5 pharmacists who are licensed under Chapter Governor appoints 5 pharmacists who are licensed under Chapter Governor appoints 5 pharmacists who are licensed under Chapter /28/2015 3:10:35 PM 6 of 6

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48 Date Submitted: 4/6/ :01:45 PM As a general matter, applications for all positions within state Government are public records, which may be viewed by anyone upon request. However, there are some exemptions from the public records law for identifying information relating to past and present law enforcement officers and their families, victims of certain crimes, etc. If you believe an exemption from the public records law applies to portions of your application, please check this box. Yes Contact 1- General Title Dr. First Name Holly Middle/Maiden Neal Last Name Moreau Address Cell Phone s (4)(d), F.S. Race African-American Gender Female Fax Disability Addresses Speficy the preferred mailing address: Residential 2- Residence Address Line 1 s (4)(d), F.S. Address Line 2 City s (4)(d), F.S State s (4)(d), F County s (4)(d), F.S. Zip / Postal Code s (4)(d) Phone Number s (4)(d), F.S. 3- Business Address Line SW 145th Ave Address Line 2 City Miramar State Florida Zip / Postal Code Phone Number Other Residences 4-A. List all your places of residence for the last ten (10) years. 7/28/2015 3:17:36 PM 1 of 6

49 Date Submitted: 4/6/ :01:45 PM Address City & State Start Date End Date s (4)(d), F.S. s (4)(d), F.S. Aug 2002 present 4-B. List all your former and current residences outside of Florida that you have maintained at any time during adulthood. Address City & State Start Date End Date Personal Information 5- Date of Birth s (4)(d), F.S. Place of Birth tampa 6- Driver License # M Issuing State Florida 7- Social Security # s (5)(a), F.S. 8- Have you ever used or been known by any other legal name? 9- A. Are you a United States citizen? Yes B. If you are a naturalized citizen, date of naturalization 10- Since what year have you been a continuous resident of Florida? 11- Vote Are you a registered Florida voter? Yes County of registration Broward Current Party Affiliation Democrat Education 12-A. High School King High school Year Graduated 1989 B. List all postsecondary educational institutions attended Name & Location Start Date End Date Certificates / Degrees Received Employment 13- Are you or have you ever been a member of the armed forces of the United States? A. Date of Service B. Branch or component C. Date & Type of Discharge 7/28/2015 3:17:36 PM 2 of 6

50 14- Concerning your current employer and for all of your employment during the last ten years, list your employer s name, business address, type of business, occupation or job title, and period(s) of employment. Employer's Name & Address Type of Business Occupation / Job Title United Healthcare Managed Care organization Sunshine Health Managed Care organization Molina Health care of FL Managed Care organization GOVERNOR'S OFFICE Date Submitted: 4/6/ :01:45 PM Pharmacy Manager Start Date End Date April 2014 present Pharmacy Director Oct 2013 Jan 2014 Pharmacy Director Dec 2008 Oct 2013 CVS Caremark PBM Pharmacy Supervisor Oct 2001 Dec Have you ever been employed by any state, district, or local governmental agency in Florida? Position Employing Agency Start Date End Date Appointments 16- A. State your experiences and interests or elements of your personal history that qualify you for this appointment I have over 12 years of experience in Managed Care and about 6 years of experience working with Managed Care Organizations that manage the Prescription benefit for Medicaid, Florida Healthy Kids and Medicare membership. In addition, I have almost 5 years of previous experience as a Plan Pharmacy Director for Molina Healthcare of FL. Combining my background and experience in Managed Care along with my diverse background in Pharmacy would make me a great candidate for this appointment. C. Have you received any awards or recognitions relating to the subject matter of this appointment? B. Have you received any degree(s), professional certification(s), or designations(s) related to the subject matter of this appointment? Yes Doctor of Pharmacy degree D. Identify all association memberships and association offices held by you that relate to this appointment 17- Do you currently hold an office or position (appointive, civil service, or other) with the federal or any foreign government? 7/28/2015 3:17:36 PM 3 of 6

51 Date Submitted: 4/6/ :01:45 PM 18- Have you previously been appointed to any office that required confirmation by the Florida Senate? Title of Office Term of Appointment Confirmation Result 19- A. Have you ever been elected or appointed to any public office in this state? Office Title Date of Election or Appointment Term of Office Level of Government (city, county, district, state, federal) B. If your service was on an appointed board(s), committee(s), or council(s) 1- How frequently were meetings scheduled 2- If you missed any of the regularly scheduled meetings, state the number of meetings you attended, the number you missed, and the reasons(s) for your absence(s) Meetings Attended Meetings Missed Reason for Absence Violation 20- Have you ever been arrested, charged, or indicted for violation of any federal, state, county, or municipal law, regulation, or ordinance? (Exclude traffic violations for which a fine or civil penalty of $150 or less was paid.) Date Place Nature Disposition 21- Has probable cause ever been found that you were in violation of the Code of Ethics for Public Officers and Employees, Part III, Chapter 112, F.S.? Date Nature of Violation Disposition 22- Have you ever been suspended from any office by the Governor of the State of Florida? Title of Office Reason of Suspension Date of Suspension Result Please Select 23- Have you ever been refused a fidelity, surety, performance, or other bond? Certifications 24- Have you held or do you hold an occupational or professional license or certificate in the State of Florida? Yes 7/28/2015 3:17:36 PM 4 of 6

52 Error: Subreport could not be shown. GOVERNOR'S OFFICE Date Submitted: 4/6/ :01:45 PM 25- Have you ever been a registered lobbyist or have you lobbied at any level of government at any time during the past five (5) years? A. Did you receive any compensation other than reimbursement for expenses? B. Name of agency or entity you lobbied and the principal(s) you represented Agency Lobbies Principal Represented Disclosures 26- If required by law or administrative rule, will you file financial disclosure statements? Yes 27- A. Have you, or businesses of which you have been an owner, officer, or employee, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Your Relationship to Business Business Relationship to Agency B. Have members of your immediate family (spouse, child, parents(s), siblings(s)), or businesses of which members of your immediate family have been owners, officers, or employees, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Family Member's Relationship to You Family Member's Relationship to Business Business Relationship to Agency References & Affiliations 28- List three persons who have known you well within the past five (5) years. Include a current, complete address and telephone number. Exclude your relatives and members of the Florida Senate. Name Mailing Address Zip Code Phone Number Mark Bloom, MD Benjamin Schatzman, PharmD 8300 NW 33rd Street, Suite 400 Doral, Florida 200 Oceangate, Suite 100 Long Beach, CA Tina Lamaa, PharmD 200 Oceangate, Suite 100 Long Beach, CA Name any business, professional, occupational, civic, or fraternal organizations(s) of which you are now a member, or of which you have been a member during the past five (5) years, the organization address(es), and date(s) of your membership(s) Name Mailing Address Office(s) Held & Term Date of Membership 7/28/2015 3:17:36 PM 5 of 6

53 Date Submitted: 4/6/ :01:45 PM 30- Do you know of any reason why you will not be able to attend fully to the duties of the office or position to which you have been or will be appointed? 31- Are you now, or in the past three years have you been, a member of any club or organization that, to your knowledge, in practice or policy, restricts membership or restricted membership during the time that you belonged on the basis of race, religion, national origin, or gender? If so, detail the name and nature of the club(s) or organization(s), relevant policies and practices, and state whether you intend to continue as a member if you appointed by the Governor? Boards of Interest Functional Category Medical & Health Medical & Health Medical & Health Medical & Health Medical & Health Board Name Seat Seat Qualification Reappointment Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee 1 Governor appoints 5 pharmacists who are licensed under Chapter Governor appoints 5 pharmacists who are licensed under Chapter Governor appoints 5 pharmacists who are licensed under Chapter Governor appoints 5 pharmacists who are licensed under Chapter Governor appoints 5 pharmacists who are licensed under Chapter /28/2015 3:17:36 PM 6 of 6

54 Date Submitted: 4/14/ :16:27 PM As a general matter, applications for all positions within state Government are public records, which may be viewed by anyone upon request. However, there are some exemptions from the public records law for identifying information relating to past and present law enforcement officers and their families, victims of certain crimes, etc. If you believe an exemption from the public records law applies to portions of your application, please check this box. Contact 1- General Title Dr. First Name Reina Middle/Maiden Last Name Natero Address Cell Phone Race Hispanic-American Gender Female Fax Disability Addresses Speficy the preferred mailing address: Residential 2- Residence Address Line N Flamingo Address Line 2 Unit 2004S City Sunrise State Florida County Broward Zip / Postal Code Phone Number 3- Business Address Line International Parkway Address Line 2 City Sunrise State Suite 400 Florida Zip / Postal Code Other Residences Phone Number A. List all your places of residence for the last ten (10) years. 7/28/2015 3:19:08 PM 1 of 7

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