Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 28, 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

Jensen Rogert Associates, Inc.

Office Address (Street, Box, or Route)

625 S. 14th Street, Suite A

Permanent Residence (Street, Box, or Route)

625 S 14th Street, Suite A

City

Lincoln

State

Zip

68508

City

Lincoln

State

Zip

68508

Office Phone

(402) 436-2165

Home Phone

(402) 436-2165

Email Address

kent@jensenrogert.com

PRINCIPAL {49-1480(2)}

Name

Molina Healthcare, Inc.

Office Phone

(661) 505-2269

Office Address (Street, Box, or Route)

200 Oceangate, Suite 100

Official to Whom Lobbyist is Accountable

Cameron Smyth

City

Long Beach

State

Zip

90802

Nature of Business {49-1480(3)}

Managed healthcare services

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
60,000.00 Per Year

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Nebraska managed healthcare services and any other matters deemed appropriate to client.

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

Names and addresses of principal's officers:

Cameron Smyth, VP State Affairs, 200 Oceangate, Ste 100, Long Beach CA
Tabitha Stokes, Director, Political Outreach (same address)

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)}

None

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

JensenRogertAssocInc

Lobbyist Name

Dec 28, 2023

Date