Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Nov 20, 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

$300.00

(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

Faustman, Nicholas

Office Address (Street, Box, or Route)

PO Box 27842

Permanent Residence (Street, Box, or Route)

11711 Arbor Street #110

City

Omaha

State

Zip

68127

City

Omaha

State

Zip

68114

Office Phone

(402) 506-9900

Home Phone

(402) 260-7907

Email Address

nfaustman@cynchealth.org

PRINCIPAL {49-1480(2)}

Name

Nebraska Health Information Initiative, Inc.

Office Phone

(402) 506-9900

Office Address (Street, Box, or Route)

PO Box 27842

Official to Whom Lobbyist is Accountable

City

Omaha

State

Zip

68127

Nature of Business {49-1480(3)}

Health Information Technology

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
80,000.00 Percentage of salary

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Issues pertaining to health information exchange, health information and prescription drug monitoring

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

Names and addresses of principal's officers:

Jaime Bland, President & CEO
Lorraine Egger, Chief Financial Officer

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.

Nicholas E. Faustman

Lobbyist Name

Nov 20, 2024

Date