Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Jan 26, 2024

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

Wogsland, Ben

Office Address (Street, Box, or Route)

500 Washington Av. S. #2060

Permanent Residence (Street, Box, or Route)

PO Box 6832 USPS Minnehaha Post Office 3033 27th Av. S.

City

Minneapolis

State

Zip

55415

City

Minneapolis

State

Zip

55406

Office Phone

(612) 224-3297

Home Phone

(612) 409-2925

Email Address

bwogsland@deltadentalmn.org

PRINCIPAL {49-1480(2)}

Name

Delta Dental of Nebraska

Office Phone

(612) 224-3297

Office Address (Street, Box, or Route)

1299 Farnam St. #300

Official to Whom Lobbyist is Accountable

Rod Young, CEO

City

Omaha

State

Zip

68102

Nature of Business {49-1480(3)}

Delta Dental of Nebraska is a Nebraska prepaid limited health service organization

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
10,000.00 Per Year

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Insurance, health care

Description of industry, trade, profession, or interests and groups represented by the principal:
Insurance industry (Delta Dental of Nebraska)

Names and addresses of principal's officers:

Rod Young, CEO of Delta Dental of Nebraska c/o Delta Dental of Nebraska 1299 Farnam St. #300

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.

Ben Wogsland

Lobbyist Name

Jan 26, 2024

Date