Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 20, 2023

Clerk of the Legislature
Room 2014, State Capitol
PO Box 94604
Lincoln, NE 68509-4604
Phone: (402) 471-2608

For Calendar Year of:

Amended Registration

Lobbyist Registration Fee:
{49-1480.01}

Compensated

$200.00

(If you are a salaried employee of your principal, you are a compensated lobbyist.)

Not Compensated

$15.00

(File a Form E for quarterly report exemption. You are not exempt from the Form D Activity Report.)

PLEASE FILL IN ALL BLANKS

LOBBYIST {49-1480(1)}

Name

Holland-Baldwin, Ari

Office Address (Street, Box, or Route)

11921 Rockville Pike, Suite 300

Permanent Residence (Street, Box, or Route)

City

Rockville

State

Zip

20852

City

State

Zip

Office Phone

(240) 292-7069

Home Phone

Email Address

compliance_ne_akf_2@multistate.us

PRINCIPAL {49-1480(2)}

Name

American Kidney Fund

Office Phone

(240) 292-7069

Office Address (Street, Box, or Route)

11921 Rockville Pike, Suite 300

Official to Whom Lobbyist is Accountable

City

Rockville

State

Zip

20852

Nature of Business {49-1480(3)}

Medical Nonprofit

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
31.00 Per Hour

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Medigap coverage

Description of industry, trade, profession, or interests and groups represented by the principal:

Names and addresses of principal's officers:

GIVE NAME and ADDRESS of any OFFICIAL in the Legislative or Executive Branch and of any members of any such official's staff or immediate family who is employed by you or by anyone acting on your behalf: {49-1480(8)}

I certify that all information presented in this form is accurate to the best of my knowledge.

Ari Holland-Baldwin

Lobbyist Name

Dec 20, 2023

Date