Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 12, 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

Nordquist, Jeremy

Office Address (Street, Box, or Route)

3255 Salt Creek Cir, Suite 100

Permanent Residence (Street, Box, or Route)

13618 Parker Circle

City

Lincoln

State

Zip

68504

City

Omaha

State

Zip

68154

Office Phone

(402) 742-8140

Home Phone

(402) 578-6442

Email Address

jnordquist@nebraskahospitals.org

PRINCIPAL {49-1480(2)}

Name

Nebraska Hospital Association

Office Phone

(402) 742-8140

Office Address (Street, Box, or Route)

3255 Salt Creek Circle, Suite 100

Official to Whom Lobbyist is Accountable

Self

City

Lincoln

State

Zip

68504

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.
8,062.00 Per Month

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Health care related issues

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

Names and addresses of principal's officers:

Jeremy Nordquist, President
3255 Salt Creek Circle, Suite 100
Lincoln, NE 68504

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.

Jeremy Nordquist

Lobbyist Name

Dec 12, 2023

Date