Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Nov 13, 2023

(This report is required to be filed on or before December 31 of each calendar year.)
49-1480.01(3)

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

Reynoldson, Amy

Office Address (Street, Box, or Route)

1045 Lincoln Mall, Suite 200

Permanent Residence (Street, Box, or Route)

City

Lincoln

State

Zip

68508

City

State

Zip

Office Phone

(402) 474-4472

Home Phone

Email Address

teresam@nebmed.org

PRINCIPAL {49-1480(2)}

Name

Nebraska Medical Association

Office Phone

(402) 474-4472

Office Address (Street, Box, or Route)

1045 Lincoln Mall, Suite 200

Official to Whom Lobbyist is Accountable

City

Lincoln

State

Zip

68508

Nature of Business {49-1480(3)}

HEALTH

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
1,025.00 Per Quarter

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} All matters of interest to the Nebraska Medical Association

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

Names and addresses of principal's officers:

President: Todd Hlavaty, 421 S. Maloney Dr., North Platte, NE 69101
Treasurer: Jason Kruger, 6701 Wildflower Ct., Lincoln, NE 68516

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.

Amy Reynoldson

Lobbyist Name

Nov 13, 2023

Date