![Received by NSD/FARA Registration Unit 01/01/2017 9:53:28 PM
OMB No. 1124-0004; Expires April 30, 2017
u.s. Department ofJustice Exhibit B to Registration Statement
Washington, DC 20530 Pursuant to the Foreign Agents Registration Act of
1938, as amended
INSTRUCTIONS. A registrant must furnish as an Exhibit B copies of each written agreement and the terms and conditions of each oral agreement
with his foreign principal, including all modifications of such agreements, or, where no contract exists, a full statement of all the circumstances by
reason of which the registrant is acting as an agent of a foreign principal. Compliance is accomplished by filing an electronic Exhibit B form at
http://www.fara.gov.
. Privacy Act Statement. Thefilingof this document is required for the Foreign Agents Registration Act of 1938, as amended, 22 U.S.C. § 611 et seq.,
for the purposes of registration under the Act and public disclosure. Provision of the information requested is mandatory, and failure to provide
the information is subject to the penalty and enforcement provisions established in Section 8 of the Act. Every registrationstatement, short form
registration statement, supplemental statement, exhibit, amendment, copy of informational materials or other document or information filed with the
Attorney General under this Act is a public record open to public examination, inspection and copying during the posted business hours of the
Registration Unit in Washington, DC. Statements are also available Online, at the Registration Unit's webpage: http://www.fara.gov. One copy of
every such document, other than informational materials, is automatically provided to the Secretary of State pursuant to Section 6(b) of the Act, and
copies of any and all documents are routinely made availabletoother agencies, departments and Congress pursuant to Section 6(c) of the Act. The
Attorney General also transmits a semi-annual report to Congress On the administration of the Act which lists the names of all agents registered under
the Act and the foreign principals they represent. This report is available to the public in print and online at: http://www.fara.gov.
Public Reporting Burden. Public reporting burden for this collection of information is estimated to average .33 hours per response, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden to Chief, Registration Unit, Counterespionage Section, National Security Division, U.S. Department of Justice, Washington,
DC 20530; and to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
1. Name of Registrant
BGR Government Affairs, LLC
3. Name of Foreign Principal
Government of Ukraine
2. Registration No.
5430
Check Appropriate Box:
4. • The agreement between the registrant and the above-named foreign principal is a formal written contract. If this box is
checked, attach a copy of the contract to this exhibit.
5. • There is no formal written contract between the registrant and the foreign principal. The agreement with the above-named
foreign principal has resulted from an exchange of correspondence. If this box is checked, attach a copy of all pertinent
correspondence, including a copy of any initial proposal which has been adopted by reference in such correspondence.
6. IS] The agreement or understanding between the registrant and the foreign principal is the result of neither a formal written
contract nor an exchange of correspondence between the parties. If this box is checked, give a complete description below of
the terms and conditions of the oral agreement or understanding, its duration, the fees and expenses, if any, to be received.
7. Describe fully the nature and method of performance of the above indicated agreement or understanding.
On December 23,2016 the Registrant and Foreign Principal agreed that the Registrant will provide strategic public relations
and government affairs counsel for the Government of Ukraine. This may include relevant outreach to U.S. government
officials, non-government organizations, members of the media and other individuals within the U.S. The Registrant and
Foreign Principal have agreed to an initial fee of USD$50,000.00 per month through December 31,2017.
FORM NSD-4
Revised 03/14
Received by NSD/FARA Registration Unit 01/01/2017 9:53:28 PM](https://image.slidesharecdn.com/5430-exhibit-ab-20170101-58-170107091715/85/5430-exhibit-ab-20170101-58-3-320.jpg)
5430 exhibit-ab-20170101-58
- 1. Received by NSD/FARA Registration Unit 01/01/2017 9:53:31 PM OMB No, 1124-0006; Expires April 30,2017 us. Department ofjustice Exhibit A to Registration Statement Washington, DC 20530 Pursuant to the Foreign Agents Registration Act of 1938, as amended INSTRUCTIONS. Furnish this exhibit for EACH foreign principal listed in an initial statement and for EACH additional foreign principal acquired subsequently. The filing of this document requires the payment of a filing fee as set forth in Rule (d)(1), 28 C.F.R. § 5.5(d)(1). Compliance is accomplished by filing an electronic Exhibit A form at http://www.fara.gov. Privacy Act Statement. The filing of this document is required by the Foreign Agents Registration Act of 1938, as amended, 22 U.S.C. § 611 et seq., for the purposes of registration under the Act and public disclosure. Provision of the information requested is mandatory, and failure to provide this information is subject to the penalty and enforcement provisions established in Section 8 of the Act. Every registration statement, short form registration statement, supplemental statement, exhibit, amendment, copy of informational materials or other document or information filed with the Attorney General under this Act is a public record open to public examination, inspection and copying during the posted business hours of the Registration Unit in Washington, DC. Statements are also available online at the Registration Unit's webpage: http://www.fara.gov. One copy of every such document, other than informational materials, is automatically provided to the Secretary of State pursuant to Section 6(b) of the Act, and copies of any and all documents are routinely made available to other agencies, departments and Congress pursuant to Section 6(c) of the Act. The Attorney General also transmits a semi-annual,report to Congress on the administration of the Act which lists the names of all agents registered under the Act and the foreign principals they represent. This report is available to the public in print and online at: http://www.fara.gov. Public Reporting Burden. Public reporting burden for this collection of information is estimated to average .49 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Chief, Registration Unit, Counterespionage Section, National Security Division, U.S. Department of Justice, Washington, DC 20530; and to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. 1. Name and Address of Registrant BGR Government Affairs, LLC 601 13th St NW, 11th Floor South Washington, DC 20005 2. Registration No. 5430 3. Name of Foreign Principal Government of Ukraine Principal Address of Foreign Principal 11 Bankova Str. 01220, Kyiv, Ukraine 5. Indicate whether your foreign principal is one of the following: H Government of a foreign country1 • Foreign political party • Foreign or domestic organization: If either, check one of the following: • Partnership • Committee D Corporation • Voluntary group • Association • Other (specify) • Individual-State nationality ., 6. If the foreign principal is a foreign government, state: a) Branch or agency represented by the registrant President Administration & National Reforms Council b) Name and title of Official with whom registrant deals Pmytro Shymkiv, Deputy Head of the Presidential Administration of Ukraine & National Reforms Council Secretary 7. If the foreign principal is a foreign political party, state: a) Principal address N/A b) Name and title of official with whom registrant deals N/A c) Principal aim N/A 1 "Government of a foreign country," as defined in Section 1(e) of the Act, includes any person or group of persons exercising sovereign de facto or de jure political jurisdiction oyer any country, outer than the United States, or oyer any part ofsuch country, and includes any subdivision ofany such group and any group or agency to which such sovereign de facto or de jure authority or functions are directly or indirectly delegated. Such term shall include any faction or body of insurgents within a country assuming to exercise governmental authority whether such faction or body ofinsurgents has or has riot been recognized by the United States. FORM NSD-3 Received by NSD/FARA Registration Unit 01/01/2017 9:53:31 PM Revised03/i4
- 2. Received by NSD/FARA Registration Unit 01/01/2017 9:53:31 PM 8. If the foreign principal is not aforeigngovernment or a foreign political party: a) State the nature of the business or activity of this foreign principal. N/A b) Is this foreign principal; Supervised by a foreign government, foreign political party, or other foreign principal Yes • No • Owned by a foreign government, foreign political party, or other foreign principal Yes • No • Directed by a foreign government, foreign political party, or other foreign principal Yes • No • Controlled by a foreign government, foreign political party, or other foreign principal Yes • No • Financed by a foreign government, foreign political party, or other foreign principal Yes • No • Subsidized in part by aforeign government, foreign political party, or other foreign principal Yes • No • 9. Explain fully all items answered "Yes" in Item 8(b). (Ifadditional space is needed, afull insertpage must be used.) N/A 10. If theforeignprincipal is an organization and is not owned or controlled by a foreign government, foreign political party or other foreign principal, state who owns and controls it. N/A EXECUTION In accordance with 28 U.S.C. § 1746, the undersigned swears or affirms under penalty of perjury that he/she has read the information set forth in this Exhibit A to the registration statement and that he/she is familiar with the contents thereof and that such contents are in their entirety true and accurate to the best of his/her knowledge and belief. Date of Exhibit A January 01,2017 Name and Title Todd Eardensohn, CFO Signature /s/Todd Eardensohn eSigned Received by NSD/FARA Registration Unit 01/01/2017 9:53:31 PM
- 3. Received by NSD/FARA Registration Unit 01/01/2017 9:53:28 PM OMB No. 1124-0004; Expires April 30, 2017 u.s. Department ofJustice Exhibit B to Registration Statement Washington, DC 20530 Pursuant to the Foreign Agents Registration Act of 1938, as amended INSTRUCTIONS. A registrant must furnish as an Exhibit B copies of each written agreement and the terms and conditions of each oral agreement with his foreign principal, including all modifications of such agreements, or, where no contract exists, a full statement of all the circumstances by reason of which the registrant is acting as an agent of a foreign principal. Compliance is accomplished by filing an electronic Exhibit B form at http://www.fara.gov. . Privacy Act Statement. Thefilingof this document is required for the Foreign Agents Registration Act of 1938, as amended, 22 U.S.C. § 611 et seq., for the purposes of registration under the Act and public disclosure. Provision of the information requested is mandatory, and failure to provide the information is subject to the penalty and enforcement provisions established in Section 8 of the Act. Every registrationstatement, short form registration statement, supplemental statement, exhibit, amendment, copy of informational materials or other document or information filed with the Attorney General under this Act is a public record open to public examination, inspection and copying during the posted business hours of the Registration Unit in Washington, DC. Statements are also available Online, at the Registration Unit's webpage: http://www.fara.gov. One copy of every such document, other than informational materials, is automatically provided to the Secretary of State pursuant to Section 6(b) of the Act, and copies of any and all documents are routinely made availabletoother agencies, departments and Congress pursuant to Section 6(c) of the Act. The Attorney General also transmits a semi-annual report to Congress On the administration of the Act which lists the names of all agents registered under the Act and the foreign principals they represent. This report is available to the public in print and online at: http://www.fara.gov. Public Reporting Burden. Public reporting burden for this collection of information is estimated to average .33 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Chief, Registration Unit, Counterespionage Section, National Security Division, U.S. Department of Justice, Washington, DC 20530; and to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. 1. Name of Registrant BGR Government Affairs, LLC 3. Name of Foreign Principal Government of Ukraine 2. Registration No. 5430 Check Appropriate Box: 4. • The agreement between the registrant and the above-named foreign principal is a formal written contract. If this box is checked, attach a copy of the contract to this exhibit. 5. • There is no formal written contract between the registrant and the foreign principal. The agreement with the above-named foreign principal has resulted from an exchange of correspondence. If this box is checked, attach a copy of all pertinent correspondence, including a copy of any initial proposal which has been adopted by reference in such correspondence. 6. IS] The agreement or understanding between the registrant and the foreign principal is the result of neither a formal written contract nor an exchange of correspondence between the parties. If this box is checked, give a complete description below of the terms and conditions of the oral agreement or understanding, its duration, the fees and expenses, if any, to be received. 7. Describe fully the nature and method of performance of the above indicated agreement or understanding. On December 23,2016 the Registrant and Foreign Principal agreed that the Registrant will provide strategic public relations and government affairs counsel for the Government of Ukraine. This may include relevant outreach to U.S. government officials, non-government organizations, members of the media and other individuals within the U.S. The Registrant and Foreign Principal have agreed to an initial fee of USD$50,000.00 per month through December 31,2017. FORM NSD-4 Revised 03/14 Received by NSD/FARA Registration Unit 01/01/2017 9:53:28 PM
- 4. Received by NSD/FARA Registration Unit 01/01/2017 9:53:28 PM 8. Describe fully the activities the registrant engages in or proposes to engage in on behalfof the above foreign principal. The Registrant will work design and implement a comprehensive government affairs and business development strategy to support the Foreign Principal's goafs of strengthening US-Ukrainian relations and increasing US business investment in Ukraine. 9. Will the activities on behalf of the above foreign principal include political activities as defined in Section l(o) of the Act and in the footnote below? Yes Ei No • If yes, describe all such political activities indicating, among other things, the relations, interests or policies to be influenced together with the means to be employed to achieve this purpose. The Registrant will build support and help open lines of communication with government and non-government organizations to strengthen US-Ukrainian relations and increasing US business investment in Ukraine. This may include relevant outreach to U.S. government officials, non-government organizations, members of the media and other individuals within the U.S. EXECUTION In accordance with 28 U.S.C. § 1746, the undersigned swears or affirms under penalty of perjury that he/she has read the information set forth in this Exhibit B to the registration statement and that he/she is familiar with the contents thereof and that such contents are in their entirety true and accurate to the best of his/her knowledge and belief. Date of Exhibit B January 01,2017 Name and Title Todd Eardensohn, CFO Signature /s/Todd Eardensohn eSigned Footnote: "Political activity," as defined in Section l(o) of the Act, means any activity which the person engaging in believes will, or that the person intends to, in any way influence any agency or official of the Government of the United States or any section of the public within the United States with reference to formulating, adopting, or changing the domestic or foreign policies of the United States or with reference to the political or public interests, policies, or relations of a government of a foreign country or a foreign political party- Received by NSD/FARA Registration Unit 01/01/2017 9:53:28 PM