Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Nov 27, 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

Wicks, Cheryl

Office Address (Street, Box, or Route)

4980 S. 118th Street

Permanent Residence (Street, Box, or Route)

City

Omaha

State

Zip

68137

City

State

Zip

Office Phone

(402) 896-3884

Home Phone

Email Address

cheryl.wicks@mosaicinfo.org

PRINCIPAL {49-1480(2)}

Name

Mosaic

Office Phone

(402) 896-3884

Office Address (Street, Box, or Route)

4980 S. 118th Street

Official to Whom Lobbyist is Accountable

Mike Lyons

City

Omaha

State

Zip

68137

Nature of Business {49-1480(3)}

Office of General Counsel

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
9,048.66 Per Year

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Matters related to IDD services and other healthcare organization matters

Description of industry, trade, profession, or interests and groups represented by the principal:
non-profit healthcare organization

Names and addresses of principal's officers:

Linda Timmons, CEO - 4980 S.118th Street, Omaha, NE 68137
Scott Hoffman, CFO - 4980 S.118th Street, Omaha, NE 68137
Jenniffer LeDoux, SVP of Operations - 4980 S.118th Street, Omaha, NE 68137
Mike Lyons, SVP and General Counsel - 4980 S.118th Street, Omaha, NE 68137
Renee Coughlin, SVP of Mission Advancement - 4980 S.118th Street, Omaha, NE 68137
Angela Weis, SVP of Mission Support - 4980 S.118th Street, Omaha, NE 68137
Heather Gunn, SVP of Mission Expansion - 4980 S.118th Street, Omaha, NE 68137
Parker SVP of HR - 4980 S.118th Street, Omaha, NE 68137

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)}

N/A

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

Cheryl Wicks

Lobbyist Name

Nov 27, 2023

Date